Trauma Insurance Case Study

By Andrew McDougall – Adviser Risk Insurance

I met with Steve and Tracey in 2010 to review their personal insurance policies. They were existing Business Services clients at the time. They operated a business in the civil and construction industry, which was going through an expansion phase, launching interstate. They had a young family, significant debt and very little personal insurance. As Steve was the key driver of the business, there was significant financial exposure in the event he was unable to work due to accident, illness or death. As a result of identifying and quantifying their financial exposure, we in turn provided recommendations to implement personal and business insurance that would reduce this financial impact. A component of these recommendations was to take up Trauma insurance. As part of this cover, in the event of a specified medical condition such as cancer, stroke or heart attack, a lump sum would be available to contribute to specialist medical costs, rehabilitation, debt payments and in Steve’s case, potential for staff replacement if Steve is off work for an extended period of time.

This year Steve was diagnosed with stage 4 lung cancer and a potentially terminal diagnosis.

Initially, Steve’s condition was treated locally, but he also sought specialist medical help both interstate and overseas, with a specialist who had particular knowledge of this condition. As a result of the great medical work being done, it was identified that Steve had a particular gene which could be targeted for treatment. Although not out of the woods, it meant there was a potential avenue to recovery. Of course, all of this comes at a cost. Private health cover does not necessarily cover these specialist medical costs let alone ongoing living expenses such as debt payments.

When contacted by Steve and Tracey about Steve’s condition, we immediately reached out to the insurer to start the claim process. This involved facilitating the claim process by helping to get the forms completed and lodged, following up the claims assessor and updating Steve and Tracey with the progress.

Having lodged the claim papers approximately three weeks prior, we received the call from the provider that the claim had been assessed and a payment of approximately $190,000 would be paid. The news was met with great relief from Steve and Tracey, as the medical bills had started to build up. This helped remove some of the financial stress that comes about as a result. Contacting the client recently, they were in the middle of a brief trip up north in warmer weather to relax and have a break from what had clearly been a stressful time.

It is still a long road to recovery with Steve continuing to undergo treatment. I will continue to get updates on his progress with the hope he makes a successful recovery. This story acts as a reminder of the importance of proper insurance, including trauma insurance. To review a current policy, or to find out more about trauma insurance for you and your family, contact your insurance adviser.

*For privacy reasons client names have been changed in this article.