Real-life claims story: Why adviser advocacy is essential

Our team of advisers at Group Plus recently helped a client with a claim, and the following real-life story highlights the invaluable advocacy role we can play in complex claims situations.

Last year, 12-year-old Sam* sustained multiple injuries from a severe motocross accident. Among other injuries, Sam suffered from serious brachial plexus damage. The brachial plexus is the group of nerves that send signals from the spinal cord to the shoulder, arm and hand. When a brachial plexus injury occurs, these nerves are stretched, ripped or torn away from the spinal cord which is, of course, incredibly painful. Sam was struggling.

After a week in intensive care, specialists suggested that there was no hope of Sam regaining the function of his arm - what a tragedy for an active 12-year-old! His parents sought overseas options but they faced the crushing hurdles of ACC declining cover for overseas treatment and Partners Life declining a claim due to ACC’s acceptance of the original injury.

Advocacy played a crucial role

Working with Sam and his family, we were able to organise a free second opinion from one of New Zealand’s top brachial plexus surgeons. This surgeon advised that he couldn’t perform the surgery to save Sam’s arm but had trained under the two top brachial plexus surgeons in the world who could. He reached out to these mentors who both offered to perform the surgery in the small window of time Sam had left for a nerve repair (a fortnight).

We presented a detailed summary of the circumstances and overwhelming evidence of the necessity for overseas treatment to senior management at Partners Life. Following our meeting, Partners Life had overturned their decision and agreed to approve the claim, paying the family the full “overseas treatment benefit” upfront which allowed them to book the surgery and travel to England.

In early December, Sam underwent advanced nerve repair in England under the expertise of the UK’s leading neurosurgeon consultant. The surgery was a resounding success. Although the surgeon indicated it will take around two and half years to recover, Sam is now expected to gain close to 100% of the normal function of his shoulder, arm and hand. Additionally, the nerve pain was completely eliminated with surgery.

Sam’s family is immensely grateful for the role our advisers played in overturning the denied claim. In the words of Sam’s mother, “What you have done for our family has given us our son back.”

We are proud to have assisted Sam and his family during this time, and we strongly believe in the role that advisers play in advocating for their clients. Insurance isn’t always easy to understand, and financial advisers really are the ones you need beside you to make sure you and your family receive the treatment and care you deserve.

*Names have been changed for privacy.