Mike Benton suggests a radical new insurance product based on protecting the insured from claiming in the first place.
Tele-claims is a much newer service than tele-interviewing but the benefits are already well understood. Office-based nurses offer sympathetic, practical and comprehensive assistance as soon as a claim is made. During the initial triage, the precise nature of the medical condition is assessed and further information requested. At this stage, a nurse with specialist training offers ongoing, empathetic support, suggesting rehabilitative treatments and recommending specialists where appropriate, minimising time spent away from work.
The importance of timely rehabilitation cannot be overstated. Study after study has shown that prompt intervention – for example, offering physiotherapy when the NHS waiting list is unacceptably long, or treatment for anxiety where the client’s confidence is shaken by their experience of illness or injury – will enable the client to recover far faster than allowing them to languish at home until they ‘feel better’.
Evidence already clearly demonstrates that a forward-thinking approach pays dividends for clients and insurers alike. The benefits of a more accurate analysis at triage stage and a creative, pro-active approach to rehabilitation mean:
- Claimants report a far more satisfying experience when they can access a ‘one stop’ process such as trained nurses with the latest technology at their fingertips. The nurses can also suggest and action a full range of therapies – physical and psychological – which can prevent a downward spiral into a long-term period ‘on the sick’.
- Insurers find that incomplete or fraudulent claims are weeded out at an early stage – for example, a project undertaken recently on behalf of one major insurer revealed that 18% of waiver of premium claimants should not be receiving the benefit due to altered circumstances which only came to light after consultations with our nurses.
- Employers clearly benefit – the average cost of absence is estimated at £666 per employee per year and QBE Insurance reported that where rehabilitation was provided, claims typically settled for a third less. The record in this country is particularly dire – only 10% of workers will return to work after a serious injury in the UK, compared with 30% in the US and 50% in Scandinavia.
However, we should not rest on our laurels just because some elements of the underwriting/claims process have at last been dragged, kicking and screaming, into the 21st century. We should look to the future and ask questions about new approaches which are flexible enough to cope with the complexities of modern life.
If it is in all our interests – employers, policy-holders, insurers and the State – to ensure that client health remains optimal, then insurance products should be far more firmly focused on preventative care. As rehabilitation has been shown to produce such markedly positive results, why not extend a common sense approach to preventing ill-health in the first place?
Protection policies are slowly evolving into more flexible products but the tele-claims process, a relative newcomer to the industry, could be the focus of an attempt to actually help protect the policyholder rather than just pay out when they are ill.
What if the insurer, via the nurse, were to primarily provide healthcare assistance, rehabilitation and preventative care? Knowing clients like a single point of contact for their queries, the nurse’s role would be extended to provide an ‘axis’ for the concerned, time-pressed consumer to source help and information for all their health issues – supplementary to the NHS.
It would no longer only be a claim which would trigger assistance. The nurse is available to advise on any medical query at any time – from quitting smoking, to dealing with stress, to vaccinations, to recommending an exercise regime – and so becoming an instantly accessible and preventative service.
If the client subsequently becomes unwell, the same nurse will assess the illness and facilitate access to a national network of drop-in clinics staffed by doctors and nurses (also available to make home visits) and the full range of rehabilitative therapies and/or counselling would be offered in the usual way.
In this scenario, prevention, treatment and rehabilitation take centre stage – with the ‘traditional’ functions of life cover, critical illness benefit and permanent health insurance available as ‘bolt-on’ options, albeit at a discounted price.
This is a medical product – or service – offered by insurers which moves beyond the traditional risk/claims assessment procedures and revolves around a single, familiar relationship. It becomes a truly holistic approach focusing on individual circumstances and using the latest technology to streamline processes. With this in place, an entirely new product with innovative features evolves and comprehensive advice can be offered.
Technology can play a major part to support the service. The client’s medical records could be instantly accessed and updated via a USB stick held by the client to take to any healthcare practitioner in this country or abroad. The nurse (who is effectively an account manager) could utilise webcam technology to help with diagnosis.
To take a step further, and accepting that the client should be for ‘life’, why not offer new clients with pre-existing conditions treatment to mitigate the problem where possible, until the premium can be offered on normal terms? This infinitely flexible product could be ‘tiered’ so that as many or as few services as are required are included, dependent upon the client’s needs and budget.
All the elements are already there. All that is required is the will to pull them together into a single policy, managed at a single, central point of access using the technology which is already available. It must be time to offer a product which offers traditional forms of insurance together with every kind of rehabilitative, preventative and elective care. The implications for savings in terms of cost, time and distress are just too significant to ignore.
Mike Benton is CEO of Medicals Direct
