Accident & Health

EMLplus offers superior claims handling for personal accident and sickness claims through a disciplined, proactive and customer-centric approach.

• Our approach offers a more comprehensive and proactive commitment to claims management. We challenge the traditional administrative approach, by incorporating the rigor of other personal injury markets to support employees in their recovery
• Our specialist personal injury focus is a point of difference within Accident & Health Insurance. We utilise our national scale, networks and expertise to benefit claim outcomes
• We leverage portfolio insights and specialist knowledge from our personal injury lines to shape our approach to specific injury and illness profiles, including musculoskeletal, mental health and terminal cancer claims
• Our Case Managers operate with reduced claims portfolios, enabling them to provide dedicated attention to every claim
• Our discipline with claims administration processes mitigates claims cost leakage, calculating payments correctly and accurately throughout the process

When an overview of claims performance is required for a policy, standard industry practice is to provide brokers with a claims bordereau. This offers a basic snapshot of claims to date along with the total costs incurred – essentially a list with minimal metrics. Rarely is a regular report provided that enables a more holistic analysis of claims performance.

EML has utilised the disciplines of our workers compensation actuarial insights and applied these to personal accident and sickness claims, to provide greater visibility of trends, themes and overarching portfolio performance.

We produce detailed performance reports that provide greater trend analysis. Where EML also manages a client’s workers compensation, we will integrate Accident & Health and workers compensation data sets to provide a single line of sight in the management of total people risk.

We bring the disciplines and governance of our workers compensation experience to our Accident & Health claims management approach. This has delivered significant savings to individual policyholders, by ensuring weekly entitlements are calculated accurately. Our triage process includes a robust review of past earnings to ensure that weekly benefits are calculated accurately and to reflect entitlements outlined in the policy schedule.

In one specific example, our triage intercepted an incorrect calculation of earnings to include overtime and bonuses. Our engagement with the policy-holder allowed us to revise the weekly benefit calculation accurately and as a result, we saved weekly claims costs amounting to $600 per week/$2,400 per month.

When the prognosis for a worker is not positive and getting back to work isn’t an option, compassion is what comes to the fore. This was the case for Olivia, Case Manager for James*, a 60-year-old full-time employee and life-long smoker. James was diagnosed with lung cancer in late 2017. His specialists advised him that his condition was both incurable and terminal.

Without a support network of family and friends close by, James became withdrawn and socially isolated. He wasn’t interested in how Olivia could help him and was suspicious, guarded and unresponsive.

Learning from experience that ill and injured workers are often scared and confused because the process is new to them, Olivia challenged herself to win his trust. She was persistent, spent time listening to his concerns and showed she was there to support him in any way she could.

When James underwent chemotherapy and radiation therapy, Olivia studied how he responded to the treatment and adapted her services accordingly. She checked on him during key stages and requested updates directly from James’ treatment providers, to reduce the stress of him explaining everything to her.

She found out what supportive social services he was receiving to make sure he was being assisted in every way possible and identified other support services available across NSW that James might qualify for.

On finding that his monthly benefit payments did not best serve his circumstances, with his permission she changed the payment schedule to better suit his needs.

As trust grew, she assisted him with setting short-term goals. On finding that he wanted to travel, Olivia visited a travel agency and brought back brochures to assist him in his plans.

Along the way, Olivia continued to keep the broker and his employer up to date with payments and claim updates via phone and email.

James now enjoys her calls and being able to speak to someone he trusts about his treatment, his concerns and his goals.

*Name has been changed for privacy purposes.