900 claims but every one matters
Jon-Paul Hale estimates he’s worked on about 900 claims over the past seven years at Willowgrove Insurance. Fewer than one percent have been declined.
Wednesday, July 23rd 2025, 1:40PM
While claims are a routine part of the job, he says there are some that stand out.
One case is that of a single, self-employed older woman who wanted to update her protection because she had only her income to support herself, and pay her mortgage.
“We put a plan together around her key thing of looking after her income and making sure that if her fears around cancer were ever realised, she was looked after. The budget was tight but there was small life and trauma, mortgage repayment, and a medical extension to her Southern Cross cover.
“On top of that, I put in place a small key person cover so that on the business side, business expenses were taken care of. Not big sums but what was needed to get the job done.”
That review happened in 2018. In 2022, the woman suffered some IBS symptoms and was uncertain about having a colonoscopy and gastroscopy done.
Hale encouraged her to and said he would sort the claims out. “We found very, very early stage bowel cancer… anything less would have been nothing there, but it was still enough for her to lose part of her bowel.”
The client had six or seven weeks of recovery, he said, and the incident resulted in 10 claims.
“We had a critical illness on the mortgage cover, we had a standard disability claim on the business cover. We had a trauma claim. We had a hospital claim. We had travel and accommodation claims on the policy, I think there were two of those in the end. It was the range of things that just kept on giving. Every corner you turned, there’s something more.
“It was the gastroscopy claim, then there’s the colonoscopy claim, then there’s the diagnosis, then there’s the surgery claim…”
Her trauma cover was reinstated a year later, and on the 23rd of December 2023, she sought treatment for a sore throat.
“She ended up with a strep cyst in her throat that put her in the ICU. In the space of a few hours she went from ‘I need to see a doctor” to ‘we’re lining you up for surgery’.”
The woman was transferred from her regional centre to a larger hospital. She was then transported by helicopter to Waikato Hospital. “She woke up three days later in Waikato ICU wondering what had gone on.”
That incident resulted in a repeat trauma claim. “It just went incredibly smoothly and she has been to a few BNI networking things with me over the year since and basically stands up and says ‘hey if I hadn’t seen JP I wouldn’t be standing here’, which is really cool.
“Talking to her a couple of days ago, I think she’s almost paid her mortgage off. She hasn’t made any regular payments to her mortgage but she’s almost paid it off with what’s come out of the claim stuff.”
In another case, Hale said he looked into the older cover that had been placed for a 65-year-old male client in a client base he took over.
“He’s a jovial chap… talking things through, I said you’ve got some stuff going on, if you ever go down the path of having the heart valve taken care of, in order for your trauma cover to respond you’re going to have to have open heart surgery.
“That was a couple of years ago. Anyway, I got a call about three or four months ago and he says ‘yeah we’re lining things up, we’re going and doing a double bypass and repairing the heart valve’.”
The man had been going to reduce his trauma cover because it was too expensive but the paperwork was never fully signed off. It turned out to be a fortunate oversight on the client’s part.
“You chase it for a bit but if it doesn’t come back, it doesn’t come back. In this case the cover hadn’t been reduced…it was about $270,000 fortunate. So he goes to have the surgery and calls me about three or four days after he’s been discharged… out of that we’ve got two insurers paying about $700,000 to them.”
More recently, a man came to see Hale who had lost his job but had a continuation option and was not sure what to do with his insurance.
Hale told him he was overinsured in a lot of ways. “We took him through a review and in that process found out he had an accident in 2023 and landed himself in the ICU. His employer took care of him and his employer, who also happens to be in financial services said don’t bother claiming…
“Anyway, I ran the ruler over it and hang on a minute you’ve got waivers of premium here, you’ve got a trauma claim in here and so there’s maybe $40,000, $50,000, $60,000 worth of stuff that we can drop into your bank account if this all lines up as you’ve outlined.
“Between premium refunds, because this is a claim from a couple of years ago, waivers of premium trauma claims, disability claims, we are sitting at about $65,000… which is not bad for picking the phone up and saying ‘hey I think I need a review’.”
He said it was disappointing that there were advisers on the policies who had not done a review with the client. “They should have been looking after him and should have known better.”
In another case, a client hesitated for two years about signing a claim form because he was sceptical about how the insurer would respond and what he would have to pay. “My comment to him was why were you paying the premium?”
The claim was accepted and paid, and the client was reassured that he did not have to part with any money. “That was a couple of years ago and more recently he had a stroke – but he didn’t hesitate to sign the claim form this year.”
Most claims in recent years had been medical claims, Hale said. “Life and trauma have dropped off a cliff and in the last 12 to 18 months disability claims have done the same. I can only put it down to a very high penetration of medical benefits in the client base and early intervention is allowing people to avoid the really serious stuff.”
Hale said most of the claims were things clients could not navigate on their own without an adviser. “Not a chance.”
He said he had settled into a technical end of the industry, primarily dealing with high value clients, high premiums and complex situations. But he was happy to work with anyone.
“I’ve got clients who spend $50 a month with us through to others that spend $7000 or $8000 a month. It’s across the spectrum and I don’t care what they spend. It’s about getting the right cover in place for what they need based on where they are.”
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