In the business of paying claims

01 April 2010 Brad Toerien, FMI

FMI is proud of a claims philosophy that provides certainty to policyholders and financial advisors when they need it the most. This philosophy, coupled with an unbeatable risk solution, is what sets FMI apart in the industry.

In 2009, FMI paid out 99.7% of all valid Temporary Income Protection (TIP) claims lodged. FMI’s definition of disability is based on the insured’s’ ability to perform the duties of the nominated occupation, either temporarily or permanently, and not on the loss of income. This occupational disability definition is inclusive of functional impairment, critical illness, and fracture and hospitalisation, which ensures that our policy benefits are extended to cover the widest range of disabilities possible.

Temporary disability: the real risk

FMI understands the different, but real, risks associated with both temporary and permanent disabilities, which is why each is offered as a different benefit. FMI’s TIP benefit provides a monthly income when the insured is unable to work for up to 24 months due to an accident or injury.

According to our claims experience in 2009, the average TIP claim spanned 87 days with only 3.7% of all TIP claims lodged extending to the full benefit term. These statistics show that temporary disability is where the real risk lies, which is why we insist on TIP being a compulsory benefit.

Extending the protection

Our Permanent Income Protection (PIP) benefit has been designed to dovetail the TIP to provide uninterrupted cover until a selected retirement age, should a policyholder become permanently disabled.

Business Overhead Protection (BOP) provides cover for the running expenses of a business during the time the business owner is incapacitated, keeping the business operational.

All three of these benefits are offered under an own occupation definition, to protect our policyholders from being unable to perform the duties of their nominated occupation as stipulated on application.

Unique in the market

A combination of factors make FMI’s claiming methodology unique in the market.

Special limited benefits: FMI offers a special pregnancy and childbirth benefit, which pays a one month benefit after the birth of a child, subject to the policy commencement date being before the date of conception. Any medical complications are treated as a normal claim. No limitations are placed on back or psychological conditions.

Waiver of premium: While a claim is being paid, FMI will waive the claimant’s premiums, providing additional financial relief.

No benefit reductions: The benefit amount payable under TIP and BOP are not subject to any benefit reduction or aggregation. FMI does not take into account any other income the claimant is receiving during the period of a claim.

Recurring claims: Repeated periods of illness are treated as one claim, so policyholders do not have to wait the full waiting period again should the disability re-occur within 24 months. Furthermore, the TIP benefit is not cancelled after a full benefit term has been paid. Policyholders may claim for another unrelated condition for their full benefit term.

Simplified claiming process: FMI will pay for the initial completion of the medical claim form by the claimant’s own doctor to speed up the claims process. No proof of loss of income or proof or pre-disability earnings are required for TIP claims.

Underwriting at application stage: FMI underwrites every risk at application stage and not when a policyholder submits a claim.

At FMI we honour our policyholders’ claims through a simple and uncomplicated claims procedure. We aim to process all claims with minimal frustration by applying a claiming philosophy which is based on many years of experience and sound client-focussed principles.

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