Our claims philosophy
Our claims decisions are made by a passionate team of dedicated claims specialists. Here’s how our people think about claims.
Steph was diagnosed with colon cancer shortly after she reduced her level of cover. While technically she was entitled to the lower amount, Steph was paid the higher amount - proving there can be discretion and empathy in the claims process.
Steph Davies* took out trauma cover to the amount of $162,000 with OnePath Life in 2002 as a healthy 38 year old woman.
As the primary carer of a young family, she wanted to ensure she was able to provide for her young children should something happen to her.
With peace of mind from having some protection in place, Steph was content with paying her annual premiums consistently for the next 16 years.
When Steph applied for her insurance with the help from her adviser, she chose to pay a stepped premium. This means that the price of her policy is determined each year at her policy anniversary based on her age at that time. The likelihood of claims naturally increases as we get older, which is why stepped premiums increase over time.
Experiencing an increasing price while never having claimed can leave people like Steph doubting whether the expense is justified. Uncertain of the value of her policy, she called OnePath Life to cancel her policy.
However, our claims statistics show that people tend to want to cancel their policies at the time when they need it most – it’s become more expensive because their likelihood to claim has increased.
During July 2018
After speaking with OnePath Life, Steph made the decision to reduce her level of cover to make her cover more affordable – rather than cancelling her cover altogether and not having any protection in place.
She decided to reduce her level of cover from $162,000 to $50,000.
In early August 2018
Steph experienced some significant cramping in her stomach. She contacted her doctor who decided to conduct some routine blood tests for further investigation. The next day, Steph’s histopathology report confirmed that she had colon cancer.
Later that same day she had emergency and life-saving surgery to remove a section of her bowel.
Luckily Steph's insurance was still in place, so she was entitled to a benefit payment for the $50,000 she was covered for under her policy.
After working hand-in-hand with Steph to submit her claim, Steph's designated claims specialist James saw it reasonable that Steph had the cancer before she decided to reduce her sum insured.
He brought Steph’s case to the in-house Claims Review Forum recommending that – with consideration given to the short time between her policy change, diagnosis and surgery, and to all the wider circumstances of her claim – OnePath Life pay her claim for the full amount of $162,000 which she had originally been covered for only weeks before.
Thanks to the diligent work of James, and the human decision-making process that determines the claims we pay, we saw it as the right thing to do to honour Steph’s claim – as a loyal customer of 16 years, and pay her the previously insured amount of $162,000.
*Whilst the names have been changed to protect the individual claimant, this case study is based on the actual circumstances of the claimant. This is for illustrative purposes only, and claims will be assessed based on the specific circumstances of each individual case.
At OnePath Life, we have the top-rated claims team in the country, and are proud to be there for our customers when they need us most.
Whilst the names have been changed to protect the individual claimant, this case study is based on the actual circumstances of the claimant. This is for illustrative purposes only, and claims will be assessed based on the specific circumstances of each individual case.
OneCare is issued by OnePath Life Limited (OnePath Life) ABN 33 009657 176, AFSL 238341. OneCare Super is issued by OnePath Custodians Pty Limited (OnePath Custodians) ABN 12 008 508 496, AFSL 238346. OnePath Life is not a related body corporate of OnePath Custodians. We recommend that you read the OneCare Product Disclosure Statement and Policy Terms available at www.onepath.com.au or by calling 133 667 before deciding whether to acquire, or to continue to hold the product.