Assignment X1.3 (vi)

[mossie]

This question relates to a specific IP claims management case (case D) where:

Claimant is unable to undertake any work due to a degenerative heart condition, which was known to the claimant at the time the policy was put in force. The claimant is a member of a group income protection scheme that applies an ’any occupation’ definition and has a free cover limit in excess of the claimant’s salary.

In the solution one of the suggestions was:
"The insurer could check whether there is any individual IP insurance, or group IP insurance from a previous employer, that may also be paying out."

I'd like to know how this works in practice? I'm surprised to know this can be done by passing the claimant due to privacy concerns; or is this solution suggesting the insurer should check with the claimant?

 

[Sarah Byrne]

Hi Mossie

I think this could be done in a couple of different ways. One option would be to ask the claimant to declare their income post sickness, and proof of this could be sought by asking, for example, for bank account records. Alternatively, insurers do have access to shared information which could show other policies individuals have, although I doubt it would show group cover. Generally when you take out an insurance policy, one of the conditions is that you are happy for your information to be shared with other insurers if requested. I know of cases of fraudulent cover that have been identified via this system.

If claimants do not release all the details and are found to have lied, this could obviously lead to quite serious consequences for the claimant. The exact action is likely to depend on the extent of the undeclared income, duration, whether the claim is still being paid and so on.

Thanks
Sarah