How Halo Uncovered More Than Fifty-Six Thousand in Benefits From Insurance the Client Already Had
A client came to Halo Advisers wanting to talk about medical insurance.
He left the review process having uncovered $56,489.90 in insurance benefits from policies he already owned.
The surprising part?
The event that triggered those claims had happened approximately two years earlier.
The client had suffered a heart attack, undergone an angiogram and had two stents inserted. He had also spent around two months away from work.
His existing insurance included Trauma Cover, Income Protection and Waiver of Premium benefits.
But he had never claimed.
This is the story of how asking a few extra questions during an insurance review led Halo to identify three separate benefits the client may otherwise never have known were available.
Identifying information has been withheld to protect the client’s privacy.
He Wasn't Looking for a Claim
In June 2021, the client contacted Halo after being referred by a close friend.
His family’s insurance had been arranged through another adviser around seven years earlier.
He wasn’t unhappy with the cover.
He simply wanted someone to look over what the family already had and discuss adding private medical insurance.
During the first conversation, Halo asked what had prompted the interest in medical cover.
That question changed the direction of the review.
The client explained that on Christmas Eve in 2019, he had experienced severe chest pain and had been rushed to hospital.
Testing found blockages in his heart.
He underwent an angiogram and had two stents inserted, and his discharge information recorded that he had suffered a heart attack.
He subsequently spent approximately two months away from work.
The Question Became: "Did You Ever Claim?"
The client’s health scare naturally made him think about medical insurance.
But Halo’s immediate question was different.
Had anyone checked whether the insurance he already had could respond to what had happened?
The answer was no.
The client held:
- Life insurance
- Trauma insurance
- Income protection
- Waiver of premium cover
The policies themselves had been reasonably comprehensively structured by the previous adviser.
The issue was not necessarily that he had the wrong cover.
The issue was that he had experienced a potentially claimable event and did not know what benefits might apply.
Halo Went Back Through the Medical Records and Policy Benefits
The client supplied his hospital notes and discharge information.
Halo reviewed the information against the benefits and definitions contained in his existing policies.
Rather than looking for a single claim, the review considered how the different types of cover worked together.
Three potential benefits were identified.
Halo then helped prepare the relevant claim documentation for submission to the insurer.
The Result: $56,489.90 Paid Across Three Benefits
Trauma Insurance: $42,624
The client’s heart attack met the applicable definition under the Partners Life Trauma Cover he held at that time.
The resulting Trauma Insurance payment was:
$42,624
This provided a lump-sum payment following the qualifying medical event.
Income Protection Critical Illness Benefit: $12,786
This was where understanding the additional policy benefits became particularly important.
The client’s income protection had a four-week waiting period.
Because he was away from work for approximately two months, looking only at the standard income protection benefit might have suggested a relatively short claim period.
However, the policy also contained a Critical Illness Benefit.
Under the terms applying to his historical policy and claim, the qualifying event resulted in six months of payments based on his monthly benefit of $2,131:
$2,131 × 6 = $12,786
Waiver of Premium: $1,079.90
The client also held Waiver of Premium cover.
This resulted in eligible premiums being refunded for the applicable period:
$1,079.90
Total Benefits Paid
- Trauma Insurance: $42,624
- Income Protection Critical Illness Benefit: $12,786
- Waiver of Premium: $1,079.90
Total: $56,489.90
These were not benefits Halo had just sold to the client.
They came from insurance he already owned.
The Real Value of the Review Was Knowing What to Look For
It would have been easy for the original meeting to focus only on the client’s request:
“Can you help me get medical insurance?”
Instead, Halo asked what had happened and why medical cover had suddenly become important.
That opened up a much more valuable conversation.
The process involved:
- Asking about the client’s recent medical history
- Reviewing an insurance package arranged years earlier
- Looking at hospital and discharge information
- Checking the relevant policy definitions
- Identifying more than one potentially claimable benefit
- Helping prepare the claims
That is a good example of why insurance advice does not finish when the policy begins.
Have You Had a Serious Illness or Injury and Never Checked Your Cover?
This case raises a simple question.
Have you experienced something significant since taking out your insurance and simply never thought to tell your adviser?
Perhaps you:
- Had a heart attack or stroke
- Were diagnosed with cancer
- Had major surgery
- Spent an extended period unable to work
- Developed a serious medical condition
- Experienced a significant injury
That does not mean you automatically have a valid claim.
Policies contain specific definitions, conditions and evidence requirements.
But if nobody has ever checked, you may not actually know.
If you have experienced a significant illness or injury since taking out your insurance and never discussed it with an adviser, ask Halo to check your existing cover before assuming there is nothing to claim.
Different Policies Can Respond to the Same Event in Different Ways
One heart attack led to three different payments in this case.
That is because each component of the client’s insurance had a different job.
The Trauma Insurance provided a lump sum.
The Income Protection policy contained a Critical Illness Benefit.
The Waiver of Premium cover helped with eligible insurance premiums.
This is also why simply knowing you “have insurance” is not enough.
You need to understand how the pieces work together.
If you are sceptical about whether insurers actually pay, you can also read our article looking at current New Zealand insurance claim figures.
Do You Actually Know What Your Current Insurance Could Do?
You may have been paying for the same policy for five, ten or fifteen years. You may barely remember what is in it. That is more common than you might think.
Halo Advisers can review eligible existing policies, explain the benefits you hold and help determine whether a previous illness, injury or other event may warrant further investigation.
If a potential claim is identified, Halo can also help you through the claims process.
** This case study relates to a historical client claim. Identifying information has been withheld. Policy benefits and definitions described in this article relate to the client’s policy and circumstances at that time and should not be interpreted as current Partners Life product terms. Every claim is assessed individually and remains subject to the policy wording, medical evidence, exclusions and conditions applying to that policy. Past claim outcomes do not guarantee future claims.