ram.menon@amoghnet.com

+61 4155 86 445

Laura's Story

Income Protection, Cancer $250,000

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Everyone at TAL has been helpful and forthcoming with information and my case worker has been fantastic. The ease of the claim process has certainly made a difference in a time where my life has been turned upside down.

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Who is Laura?

Laura is a 27 year old dentist who recently used all of her savings to purchase her first property.

What happened to Laura?

While holidaying in Japan, Laura was diagnosed with a brain tumour. Laura's treatment has included two surgeries, radiotherapy and chemotherapy.

The good news is that Laura had a TAL Income Protection Policy, which to date, has provided her with monthly disability benefits totalling around $250,000 to date. So during the chaos of her illness, Laura hasn't had to worry about the stress of covering her bills. Laura's adviser also arranged the necessary paperwork with TAL to ensure she didn't have to think about anything other than her recovery.

Where is Laura now?

Laura is currently at home, dealing with her illness one day at a time. While the outlook is uncertain, minimising the financial stress means she can focus on her health and spending quality time with her family.

John's Story

TPD, Parkinson's Disease $1.3m

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I was at a complete loss when I could no longer work as a surgeon and it has been hard to accept my future with Parkinson's. Thank heavens for my TAL TOP Payment. I don't have to worry about my ongoing care and we can enjoy our lives as much as possible.

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Who is John?

John is 56 and a successful surgeon. He is married with two university-aged children still living at home.

What happened to John?

Over a recent period of time, John developed some concerning symptoms which eventually led to a diagnosis of Parkinson's disease. As a surgeon, a steady hand is imperative, so this diagnosis has meant John can no longer work in his field of expertise.

Thankfully John had a Total and Permanent Disability (TPD) policy with TAL, which specified that in the event that he could no longer work in his occupation he would receive a lump sum payment.

Where is John now?

John was able to use his TPD payment to relocate with his wife and their two sons to a single-story house that would be more suitable as his condition progressed. The payment also meant their lifestyle would be protected so they could focus on quality of life.

Allen's Story

Critical Illness, Non-Hodgkin Lymphoma $400,000

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The TAL claims team were so friendly and supportive. They did everything they could to help Wendy and I get through the hardest time in our life together.

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Who is Allen?

Allen is a 53 year old solicitor living in regional Victoria.

What happened to Allen?

Allen's wife Wendy had just recovered from a battle with thyroid cancer when they received the horrible news that Allen had Non-Hodgkin Lymphoma. The doctors told Allen that it was likely that he would have to have a stem cell transplant followed by radiotherapy.

Living in the country meant that Allen would have to travel a long way from home to get the treatment he needed. With the money that Allen received through his TAL Critical Illness Policy, he and Wendy could afford to rent a property in Melbourne that was close to his doctors and the hospital.

Where is Allen now?

Allen is in remission and he and Wendy are back at their home in regional Victoria. They still travel back and forth from Melbourne so that Allen can see the specialist for regular check-ups.

Commercial Property

EXAMPLE ONE

Industrial special risks

An industrial dryer damaged by fire was successfully renegotiated after the insurer rejected the claim.

Claim background

A fire broke out in our client’s industrial dryer. The fire destroyed the industrial dryer, however, no further damage to the client’s building or the site was determined.

The claim was originally declined by the insurer. It was initially determined by the assessor that the fire was likely due to the dryer spontaneously combusting. The insurer cited that spontaneous combustion was excluded under the relevant policy.

Resolution

In order to confirm whether the insurer’s assertion was accurate Amoggh claims advocate reviewed the documentation and reports and identified that the repairer’s report indicated that while the fire was caused by spontaneous combustion, it was the clothing rather than the dryer itself that combusted.

In light of the new determination, Amoggh advocate was able to argue that as the cause of the damage had not been spontaneous combustion of the dryer but rather the clothing catching alight, the exclusion relied upon did not in fact apply in these circumstances.

The insurers ultimately accepted the position put forward and paid the approximately $11,000 claim.

Commercial Property

EXAMPLE TWO

Business interruption

Identifying additional entitlements enabled a broader claims settlement for a bushfire-preventing access case.

Claim background

Our client operates two tourism properties that were significantly impacted during the New South Wales and Victorian bushfires from November 2019 to January 2020. While there was minor property damage at each site, the primary cause of disruption to business operations was the wider area impact of the bushfires and the prevention of access to the site through various mandated road closures.

Our client initially prepared their own claim submission, incorporating their perceived losses during the impacted period. The insurers’ claims assessors contacted our claims team, noting significant concerns with the calculation being put forward and questioning the methodology behind the submission.

Resolution

The Amoggh team was engaged to review the submission and was
able to work through the assessors’ concerns with our client. As the client’s initial claim submission had been made under only one part of the policy we were able to identify additional cover in the policy which widened the scope of their ability to claim and doubled the available pay-out on their loss.

The team then rebuilt the submission, tailoring it around the appropriate policy wording and the value of the disruption calculated using the methodology specified by the policy.

Domestic

EXAMPLE ONE

Jewellery theft

Home break in jewellery theft.

Claim background

Following a break and enter at their home, our client found their jewellery had been stolen. The claim had stalled for a number of months with the insurer not issuing settlement for a significant portion of the jewellery where proof of purchase was not provided. They advised that their primary concern was that the claimed loss was not sufficiently justified and appointed their in-house investigations team and assessors to review the loss.

Resolution

In light of this delay, the claim was escalated to Amoggh who provided information the insurer had indicated they would accept and cited the obligation for all parties to act in good faith under the Insurance Contracts Act 1984.

The claim was ultimately paid due to the strength of the claims advocate’s position in supporting the case for the client to be paid to the full limit available.

Domestic

EXAMPLE TWO

Home fire

A prestigious home destroyed by fire.

Claim background

Our client is the owner of a prestigious property in a well-known wine-growing region. Due to a micro-fissure in the mortar of the fireplace the property caught fire in the middle of the night and burned to the ground.

The insurers sought the appointment of a quantity surveyor to assist in forming a view as to the overall costs associated with rebuilding of the home and closing the claim down as quickly as possible.

Subsequently, the insurer issued an initial global settlement offer that fell well below the client’s expectations and did not meet the actual costs of rebuilding the property. Additionally, the insurer did not want to issue payment for alternative living expenses to the client as this was not their primary home and they had other properties where they could stay.

Resolution

Together with the client Amoggh devised a strategy that involved the review and reformulation of the claim, in conjunction with the client’s architect. This allowed a line by line analysis document to be created for presentation to the insurer for consideration.

After this document was submitted the claims handler attended discussions between the client and the insurer’s representatives to provide support where needed.

Following a series of strong negotiations the client received a revised offer from the insurer which was in excess of $1 million more than the original offer and included payment for alternative living expenses.

Liability

EXAMPLE

Energy company

An unusual leakage threat and a bespoke policy added to the complexity of this liability claim.

Claim background

Our client is an experienced oil producer and explorer with interests in a number of oil fields across Australia. During routine inspections at one of their major processing facilities a leak was identified in the water injection pipeline between our client’s processing facility and the
beach. On closer inspection the leak was found to be a combination of both seawater and hydrogen sulphide which is toxic to people.

To meet the client’s risk transfer requirements, cover had been provided under a bespoke policy which provided for evaluating, monitoring, controlling, removing, nullifying and/or clean-up the site. Given this coverage was rarely, if ever, claimed on, Gallagher firstly approached
gaining acceptance of indemnity to progress assessing the significant costs incurred in addressing this leakage.

Resolution

Amoggh discussed in detail with insurers what the coverage under this policy was designed to respond to and if first party losses should be covered. These discussions included closely analysing the terms of the policy and how the client’s incident matched the requirements.

The underwriters agreed that our views were correct and the calculation of the costs commenced.