our commitment is to ensure every claim that …...accountant 44 spinal muscular atrophy $689,063...

Life’s better with the right partner®

Our commitment is to ensure every claim that should be paid, is paidFOR ADVISERSMarch 2015

2 Claims brochure

You can tell a lot about an insurance company by the way it handles claimsAs a company that protects the lives of more than 3.1 million Australians, we’re committed to making a potentially stressful time, as smooth as possible. Our experienced claims team is committed to ensuring that every claim that should be paid, is paid.

In 2014, we paid out over $860 million in claims – that’s over $3.4 million every working day.

Claims paid in 2014 ($)

Death $419,427,057

Total and Permanent Disablement (TPD) $218,214,987

Crisis Recovery $34,825,041

Income Protection (IP) $188,514,465

Other (including CCI & Whole of Life) $792,943

Total $861,774,492

Causes of claimsHeart disease and cancer continue to be two of the leading causes of death in Australia1 and accounted for the majority of Death and Crisis Recovery claims we paid out in 2014.

Our definitions for both heart disease and cancer are market-leading, enabling our customers diagnosed with these illnesses to claim when they need it most.

Cancer – a leading cause of death2

• An estimated 128,000 new cases of cancer will be diagnosed in Australia this year, with that number set to rise to 150,000 by 2020.

• Cancer accounts for about 3 in 10 deaths in Australia.

• The most common cancers in Australia (excluding non-melanoma skin cancer) are prostate, bowel, breast, melanoma and lung cancer.

1 http://www.abs.gov.au, accessed 16 February, 2015.2 http://www.cancer.org.au/aboutcancer/FactsFigures.htm, accessed 16 February, 2015.

3Claims brochure

Death claimsTop 5 causes of Death claims we paid out in 2014

Cancer

Cardiovascular

Diseases of the digestive system

Stroke

Respiratory

Neurological

Other*

Cancer

Cardiovascular


Stroke

Respiratory

0% 5% 10% 15% 20% 25% 30% 35% 40%

28%

54%

47%

10%

13%

28%

6%

4%3%

4%4%

4%

3% 3% 2%

Death claims by gender and age

Male Female

Cancer

Cardiovascular


Stroke

Respiratory

Neurological

Other*

Cancer

Cardiovascular


Stroke

Respiratory

0% 5% 10% 15% 20% 25% 30% 35% 40%

28%

54%

47%

10%

13%

28%

6%

4%3%

4%4%

4%

3% 3% 2%

* Other causes include: Complications of pregnancy, skin disorders, infectious diseases, suicide/suspected suicide, endocrine disorders (e.g. diabetes), deaths referred to the coroner and musculoskeletal conditions resulting from accidents.

YOUNGEST CLAIMANT

15 YEARS

OLDEST CLAIMANT

76 YEARS

AVERAGE AGE

48 YEARS

Breast cancer made up 13% of all female cancer Death claims in 2014.

4 Claims brochure

Total and Permanent Disablement (TPD) claimsTop 5 causes of TPD claims we paid out in 2014

Musculoskeletal

Cancer

Mental health

Neurological

Cardiovascular

Stroke

Other*

Musculoskeletal

Neurological

Mental health

Cancer

Stroke

0% 10% 20% 30% 40% 50%

38% 38%

14% 9%

20%

11%19%

15%

2%10%

4%

5%12%

3%

TPD claims by gender

Male Female

Musculoskeletal

Cancer

Mental health

Neurological

Cardiovascular

Stroke

Other*

Musculoskeletal

Neurological

Mental health

Cancer

Stroke

0% 10% 20% 30% 40% 50%

38% 38%

14% 9%

20%

11%19%

15%

2%10%

4%

5%12%

3%

* Other causes include: Complications of pregnancy, accidents, skin disorders, infectious diseases, Chronic Pain Syndrome, facial injuries, endocrine disorders

(e.g. diabetes), respiratory conditions and diseases of the digestive system.

What are musculoskeletal conditions? In 2014, musculoskeletal conditions were the leading cause for TPD claims we paid out.

Musculoskeletal conditions affect the bones, muscles and their attachments, including joint problems. There are more than 100 musculoskeletal conditions, with the most common being osteoarthritis, rheumatoid arthritis, osteoporosis and back pain.

Conditions our customers claimed for included back or neck conditions, fractures, arthritis and injuries sustained in accidents.

5Claims brochure

Examples of TPD claims we paid in 2014

Occupation Age Cause Benefit paid

Manager 53 Depression $1,041,863

Builder 58 Spine and trunk injuries $578,813

Executive 34 Breast cancer $1,800,000

Construction Manager 62 Stroke $502,692

Research and Development Manager 46 Lung cancer $2,000,000

Surgeon 49 Multiple sclerosis $1,260,000

Labourer 47 Blindness $173,644

Accountant 44 Spinal muscular atrophy $689,063

General Manager 51 Paraplegia $2,094,750

Accounts Clerk 58 Parkinson’s Disease $255,256

Rehabilitation – the road to recovery

Helping your clients get back to work

At AIA Australia we understand the value of rehabilitation and we’ve changed the way we approach claims to ensure Return to Work (RTW) plans are considered from the moment a claim hits our desks: • We have one of the largest rehabilitation teams in the

industry, with over 110 + years combined experience.• Recruited allied health professionals into our

claims teams.• Up-skilled our claims assessors to identify

suitable rehabilitation claimants.• Rehabilitation screening tool embedded in

claims processes.

Our extensive trials confirm that rehabilitation opportunities identified through early intervention resulted in an increased number of our customers successfully returning to work.

In terms of physical conditions, if a person’s off work then the chance of them ever getting back to work• after 20 days is 70%• after 45 days is 50%• after 70 days is 35%

The right partner

Our rehabilitation team includes rehabilitation counsellors, physiotherapists, occupational therapists and a registered nurse, who work in partnership with medical practitioners to plan and manage your client’s recovery and assist them in returning to work.

Rehabilitation isn’t just about the physical recovery. Helping claimants, especially those who are self-employed, restores more than their income, it can also help restore their identity and self-esteem.

Our RTW programs are holistic, considering each individuals social situation, psychological factors and other health conditions.

Each claimant receives a tailored program which can include modification of work environments, work-related counselling, graded RTW programs, re-skilling/retraining or career advice and redirection.

Our rehabilitation services achieved an 80% return to work rate in 2014, compared to the industry average of 54%3.

3 Based on the Swiss Re Rehabilitation Watch 2014

6 Claims brochure

Crisis Recovery claimsTop 5 causes of Crisis Recovery claims we paid out in 2014

Cancer

Cardiovascular

Stroke

Neurological

Other*

Cancer (excluding breast cancer)

Cardiovascular

Breast cancer

Stroke

Neurological

0 10 20 30 40 50 60

64% 81%

23%

5%

5%6%

2% 8%3%

3%

45%

Crisis Recovery claims by gender Male Female

Cancer

Cardiovascular

Stroke

Neurological

Other*


Cardiovascular

Breast cancer

Stroke

Neurological

0 10 20 30 40 50 60

64% 81%

23%

5%

5%6%

2% 8%3%

3%

45%

* Other causes include: Infectious diseases, musculoskeletal conditions, diseases of the digestive system, respiratory conditions and coronial investigations.

All too common causesOver recent years the number of Crisis Recovery claims we have paid for cancer has risen from 134 claims in 2012, to 183 claims in 2014. As the disease continues to be a leading cause for both Death and Crisis claims, we’ve structured our cancer definitions to be the best in the market.

Breast cancer4

• In 2015, it is estimated that 15,600 women will be diagnosed with breast cancer.

• The risk of developing breast cancer increases with age; the average age of first diagnosis in women is 60 years.

• One in eight women will develop breast cancer in their lifetime.

45% of all female Crisis Recovery claims for cancer were for breast cancer.

Breast cancer also accounted for 14% of total Crisis Recovery claims.

4 http://www.bcna.org.au/about-breast-cancer, accessed 16 February, 2015

7Claims brochure

Heart diseaseAfter cancer, cardiovascular problems were a major cause for our Crisis Recovery claims. The vast majority of these were male claimants, with heart conditions making up 23% of all male Crisis Recovery claims in 2014.

In Australia, every nine minutes someone suffers a heart attack.5 Your clients can be assured that if they need to make a claim, we’ll pay a crisis recovery benefit for any heart attack that meets our market-leading definition.

A crisis event can happen to anyone

Help when it matters• Over 95% of Australians do not have adequate levels of life insurance6.

• One in five men and one in seven women will suffer a critical illness before age 647.

As the cost of living increases, many people look for ways to cut back where they can, including cancelling their life insurance to free up extra cash flow.

While cutting back on this expense may make sense to your clients in the short term, it could cause them significant financial hardship in the future, in the event of the unexpected diagnosis or life changing event.

The insurance gap in 2014

40 4442 4741 45 4643 48 49 50

39.7 YEARSAverage age of customers who took out Crisis Recovery cover

50 YEARSAverage age of claim

42.5 YEARSAverage age of cancellation

YOUNGEST CLAIMANT

25 YEARS

AVERAGE FEMALE AGE

48 YEARS

AVERAGE MALE AGE

51 YEARS

OLDEST CLAIMANT

68 YEARS

At AIA Australia, we have a number of innovative product solutions which may address concerns around premium affordability. Contact us to find out more.

5 http://www.heartattackfacts.org.au, accessed 16 February 20156 Lifewise/NATSEM study, 20107 Rice Warner Report on Underinsurance in Australia 2011

8 Claims brochure

Income Protection (IP) claimsTop 5 causes of IP claims we paid out in 2014

Musculoskeletal


Neurological

Breast cancer


Stroke

Cardiovascular

Mental health

Other*

Musculoskeletal

Mental health


Neurological

Breast cancer

0 10 20 30 40 50

39% 38%

14%7%8%

4%

4%

4%

10%7%

11%

9%

3%3%

1% 18%20%

IP claims by gender Male Female

Musculoskeletal


Neurological

Breast cancer


Stroke

Cardiovascular

Mental health

Other*

Musculoskeletal

Mental health


Neurological

Breast cancer

0 10 20 30 40 50

39% 38%

14%7%8%

4%

4%

4%

10%7%

11%

9%

3%3%

1% 18%20%

* Other causes include: Infectious diseases, coronial investigations, Chronic Pain Syndrome, skin disorders, complications of pregnancy, respiratory conditions,

facial injuries, suicide/suspected suicide and endocrine disorders (e.g. diabetes).

Examples of IP claims we paid in 2014

Occupation Cause Age Benefit

Physiotherapist Breast cancer 54 $28,188

Accountant Shingles 52 $8,176

Environmental Research Scientist Melanoma 47 $117,439

General Electrician Burns 31 $360

Sales Representative Depression 51 $85,505

Hairdresser Stroke 22 $26,709

Animal Trainer Chronic back pain 32 $2,060

Carpenter Fracture 37 $153,543

Architect Broken thighbone 58 $68,486

General Manager Parkinson’s disease 49 $52,991

9Claims brochure

Helping people when they need us mostReasons for declining a claimIn 2014, we paid over $860 million in claims with a 92.9% acceptance rate.

We’re committed to the prompt assessment and payment of valid claims. However, if we do have to decline a claim it’s generally for one of these reasons:

The claimant doesn’t qualify for a Crisis Event

We cover up to 49 Crisis Events. Your client must meet the definition of a Crisis Event as listed in their policy. If their condition isn’t listed, or the severity of their condition does not meet the definition, they will not be eligible to claim.

The claimant didn’t disclose a pre-existing condition at the application stage

Not disclosing a pre-existing condition upfront can impact your client’s claim so it’s vital that all pre-existing conditions are disclosed at the application stage to avoid us possibly having to decline the claim.

What you can do to help your client make a claim• Before the claim, communicate the benefits your client may be entitled to in order to ensure pre-existing

conditions are disclosed;

• Help with completing documentation AIA Australia requires;

• Help gather financial evidence if it’s required;

• If mobility is a challenge for your client, consider offering to assist them with arranging transportation to see their treating doctor (where practical and appropriate) to complete the claim form;

• Follow up any outstanding requirements which may slow down the claims payment; and

• Reassure your client that AIA Australia will consider their claim with empathy and integrity.

AIA07045 – 03/15

Copyright © 2015 AIA Australia Limited (ABN 79 004 837 861 AFSL 230043). All rights reserved. The life insurance policies relating to Priority Protection and Priority Protection for Platform Investors are issued by AIA Australia. This publication has been prepared for distribution to financial advisers only and is not for wider distribution. This information is current at the date of this publication and is subject to change. This provides general information only, without taking into account factors like the objectives, financial situations or needs of any individual. Before acting on the information in this publication, individuals should consider its appropriateness having regard to such factors. Individuals should also obtain a PDS relating to these products (available at aia.com.au) before making any decision about whether to acquire any of them. This publication is only a summary of the circumstances in which AIA Australia pays claims under Priority Protection and Priority Protection for Platform. The payment of claims is subject to the terms and conditions of the relevant product as summarised in the relevant PDS. For further information on the circumstances in which AIA Australia would pay claims please contact your client development manager and review the relevant PDS.

For more information contact a member of the AIA Australia Client Development team on 1800 033 490 or visit AIA.COM.AU

our commitment is to ensure every claim that …...accountant 44 spinal muscular atrophy $689,063...

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