Case Study
1. Wife And Husband
She is a Hongkonger, a wife, and also an investment banker storming through the market in the financial industry. With a monthly income of 200k HKD, she is not the normal housewife that you may think she is. Earning yourself a position in the investment banking department is easier said than done. Bankers have a clear mind which supports the problem solving skills they need in the unpredictable money games. She is such a tough and reliable woman that it could hardly be imagined that any obstacle can beat her.
Her story became totally different when illness knocked on the door. It was a brain tumor. Her husband got it, and it was devastating to the couple. All of a sudden, the peaceful middle-class life has come to an abrupt halt. Her mind was full of questions like how can she help her husband to fight the battle? What about the medical expenses? What about the ongoing projects back in the office? The only good news back then was that they both purchased the AIA CEO medical plan and the medical expenses could be covered. Once Wendy heard of the situation, she made a quick call to her customer and asked if she could do anything to help. She was worried. The only thing that Wendy could do was to check on the claiming procedures and make sure that the couple could know what is happening in the course of claiming the medical expenses. When it comes to critical illnesses, it is not only the patient who suffers. Caregivers are often put under tremendous pressure as they have to take good care of their loved ones and at the same time keep everything else in normal order.
Investment bankers are the invincibles, at least this has been what people are saying among the financial industry. The fact is, people do not seem to realize how vulnerable they are until disaster strikes. The wife had a mental breakdown when her husband was sent to the hospital. The things that she had to worry about were just too much. She was completely overstretched by the medical procedures, projects back in the office and giving care to her husband. At one point, she did not seem like an investment banker, but simply a wife who was so panicked and relentlessly called Wendy to ask for insurance claims. In fact, when it comes to claiming medical expenses at hospital, insurance companies usually need a certain period of time to pass all required documents to the underwriting department before the claim can be granted.
With years of experience working in this industry, Wendy understood what the wife was going through and she was sympathetic to her situation. The wife was not the first client, nor she would be the last client who went out of her mind in case of critical circumstances. Wendy knew that all they needed was more care and professional service. She didn’t argue with the wife regarding the claiming procedures because it would not be very helpful considering the circumstances back then. A few weeks later, a one million HKD cheque was handed to the couple, the case was settled.
2. Special Health Disease
Steve Jobs once said that when he was told that he got pancreatic cancer, he didn’t even know what a pancreas is. Believe it or not, critical illnesses are far more complicated than we have ever imagined. Until this day, scientists are still discovering new illnesses that people are suffering from. XX cancer is an extremely rare illness. The chance of getting this sickness is nearly one of a hundred thousand. Wendy has a friend, and he was one of the people that wasn’t fortunate enough to avoid this rare disease.
He was lucky, an early discovery of the cancer has bought him time for effective medical treatments. Thanks to the medical technology and doctor’s effort, he defeated the cancer and recovered after receiving medical care. 10 years later after his victorious battle against the illness, he had an afternoon tea appointment with Wendy, and he shared his experience with her fighting cancer. When Wendy asked him about his medical expenditure, it struck him a little bit odd as he finally realized that he forgot about the medical claims! Years ago he purchased a medical insurance policy from P Company, a claim should not be available anymore theoretically due to the contractual restrictions of the policy. Wendy recommended him to give it a try. No loss, afterall. She accompanied him to P Company’s office and filled in all the required documents for the claiming procedures. The paperwork was not too complicated, whether he can make the delayed claim successfully did not depend on how good was his reasons for the delay, but on the leniency and the attitude that an insurance company had when serving their customers.
A few weeks later Wendy received a phone call. Her friend got the claim approved and received an amount of 800k HKD. He said he never expected such an amount of money after all these years. He thanked Wendy for her advice and expressed his excitement after getting the money. This amount later became his education fund and he used that to pay off tuition fees for his master degree.
City dwellers often have different kinds of misconceptions and misbeliefs over insurance companies, seeing them as companies only maximize their profits and always exploiting customer’s interest.
Many of these beliefs are merely myths in the industry, yet not many people would have a chance to know more about the truth. We need protection, insurance companies provide us a medium, a method to transfer some of the risk from ourselves to the insurance companies.
Despite being a commercial institution, the mission of an insurance company is not exploiting customers, but to offer them quality service and protection, such that the business can thrive in a sustainable and healthy manner.
3. Claiming Difficulties
Wendy has a client who is a cervical cancer patient. This type of cancer kills thousands of people in the world every year, with more than 570k new cases over the past year.
She was worried when she was told that she had cancer. Having that said, having faith in modern medical technology, she knew that doctors could help her. She needed to have faith.
The first thing that doctors could do was to examine the cancer cells in her body. They conducted an in-vivo cell extraction, in a private hospital. When the medical report was out, she was devastated as the cancer cells were showing aggressiveness, which indicates a more severe type of cancer. Doctor’s advice was to conduct a medical surgery and remove the tissue.
The operation was a success. She could finally be a bit relieved. After the removal, a second cell extraction was conducted in a public hospital, and the result was dramatic. Medical report showed no aggressiveness from the cancer cells, which means the removal surgery was superfluous. She was stunned when she heard that. All the pain that she suffered, all the worrying from her family, all the medical expenses were induced by a medical error. She was furious as she felt like being tricked by all the medical staff in the hospital.
Another issue came, medical insurance coverage. At that time she was holding two critical illness insurance policies from AIA and M company respectively. When it comes to claiming the sum insured in a policy, both companies require aggressive cancer with medical proof. The issue is that she had got two conflicting medical reports, so which one would insurance companies rely on when she makes her claims? There is a hidden rule in the industry that companies would treat their old customers more leniently when it comes to claiming. She had been a customer of M company for over two decades, while she had purchased a critical illness policy from AIA for no more than a few years. Therefore, she went to M Company first. The thing did not turn out as she had expected. AIA granted the claim, while M Company rejected.
She called on M Company’s service agent and asked for an explanation. She was then told that M Company had relied on the second medical report which showed a negative result on the aggressiveness of the cancer cells thus rejected the claim. AIA, to the contrary, allowed the claim once there was a single medical report, whatever and whenever it had been made, which showed aggressiveness of cancer cells.
The corporate objective of AIA is to serve and to protect. Despite all the complexities in the terms and conditions of the insurance policy, AIA does not want to use them as a tool to reject claims. It is the trust and confidence from our customers that keep AIA thriving and achieving in this industry throughout all these years.