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Where in the Code is this?

I've had a client with a hard time with an accident injury, and they have little in the way of support.

Thursday, May 4th 2023, 12:00PM

by Jon-Paul Hale

The husband works out of town, has two young kids, and has an accident injury that requires surgery. Just a typical New Zealand family doing their thing.

Now many might say where's the insurance? There is some, but it's not helping here, so they rely on ACC.

Now being an adviser that assists with claims, when it comes to ACC stuff, I'll help here too. Claims often have both insurer and ACC involved.

The challenge is the code doesn't cover this stuff; it doesn't cover claims or what we have to manage with clients. It doesn't cover ACC at all, as it's excluded in FSLAA.

Frankly, as an industry, we are not training our advisers on claims management or providing them with the skills needed to manage what follows either.

To set the scene, we have a young mother on her own with no family support, post-surgery incapacitated under specialist orders for six weeks, with two school-age kids. In a two-level house, the surgery is a revision of a prior surgery that didn't work three years prior.

In the space of a week:

*The ACC-provided home help doesn't arrive until 45 minutes after they are needed because the service won't schedule this correctly.
* The drivers for the kids to and from school grumble because they are late because of the initial delay.
* The carer assigned to our client doesn't prep and make meals as directed by ACC, and the family has chips and crackers for three days due to that being all that the incapacitated mum could reach.
* The carer disappears at odd times, with the kids home but not in bed.
* Assaults our client on the basis they expect our client to be doing more (6 weeks incapacity bed rest from the specialist one week in).
* The kids are left alone at two external event centres without adult supervision. The driver service is not a child-minding service.
* And the two ACC-approved providers in between don't have a complaints process or problem-solving process.

Frankly, I'm appalled, and this is on top of what has been in the past, pre-Covid, which wasn't a great experience either.

What do you do with this?

And before you say hand this off, to whom?
* The people responsible are failing this family, one who is also your client.

Where in the code does it cover failure to provide basic needs?
* This is all stuff that our present insurance policies do not have provisions for.
* The injury and surgery don't qualify for either trauma or disability claims.
* If there was disability cover in place, there could be some contribution to home assistance, but that wasn't available to this client due to pre-existing conditions (more than 4).

You're left with a pretty heart-wrenching situation on your desk and nowhere to go with it. Sure, you can try ACC if you can get through and get them to understand what the issue is.

End of the day, these situations are the reality we have to contend with, and as a human, walking away isn't an option either.

Those looking in often throw shade on what we earn with commissions, completely missing all of the unpaid work we do in situations like this. This isn't an isolated situation either; there are hundreds of these around the country with advisers right now!

There is no recognition of the impact on advisers' mental health with this, advisers who are often working alone or have limited peer support.

It is no wonder the stats for advisers claiming mental health disabilities are some of the highest occupations with insurers.

It has taken working as an adviser to appreciate that the stresses we face daily assisting people in need and crisis are not recognised nearly as well as they should be inside and outside the industry. I hope I've brought some light on this for people.

We have all seen the tragic reality of suicides in Australia with our counterparts there in recent times, and with the new regime here, albeit not nearly as bad as Aussie's, we need to be mindful and avoid the same things happening here.

As to this family, they'll get through it. I'll work through the complaints processes needed and push for new and better support from ACC. And we'll discuss the assault with the Police as well.
Someone incapacitated in their own home and assaulted by a carer is not how we do things.

Keep fighting the good fight, keep at it, and remember there's always someone around to reach out to that can help, maybe only listen; sometimes that's all that's needed.

And remember, we have a lot of support available inside the industry and public tools.
* Some advisers will have access to what was called Best Doctors service provided to advisers by a couple of insurers.

For counselling and support

• Lifeline: Call 0800 543 354 or text 4357 (HELP)
• Suicide Crisis Helpline: Call 0508 828 865 (0508 TAUTOKO)
• Need to talk? Call or text 1737
• Depression helpline: Call 0800 111 757 or text 4202

For children and young people

• Youthline: Call 0800 376 633 or text 234
• What's Up: Call 0800 942 8787 (11am to 11pm) or webchat (11am to 10.30pm)
• The Lowdown: Text 5626 or webchat

For help with specific issues

• Alcohol and Drug Helpline: Call 0800 787 797
• Anxiety Helpline: Call 0800 269 4389 (0800 ANXIETY)
• OutLine: Call 0800 688 5463 (0800 OUTLINE) (6pm-9pm)
• Safe to talk (sexual harm): Call 0800 044 334 or text 4334

All services are free and available 24/7 unless otherwise specified.

Tags: Jon-Paul Hale

« Things advisers should be doing at claim timeNew Regime, New Thinking »

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