You will be able to guide a client or their family through a claim calmly and accurately.
The message comes on a Tuesday evening. It is from the daughter of Kumar, a client Wei Ling has looked after for six years. Her father died this morning. She found Wei Ling's card in his drawer and does not know what to do. Everything you learned in the earlier modules was about getting the advice right. This is the moment the advice was for, and it is the moment most clients and families will judge you by.
You cannot learn an insurer's claims process at the moment a grieving family needs it. Learn it in advance, for every insurer whose policies you advise on, and for each common type of claim: hospitalisation, critical illness, disability and death.
For each one, find out how a claim is started, which forms are needed, which supporting documents the insurer usually asks for, where they are submitted, and roughly how long each stage takes. Find the insurer's claims contact and your own firm's claims support contact, if it has one. Keep all of it somewhere you can reach from your phone.
This preparation is also how you avoid promising things you do not know. A representative who knows the process can tell a family exactly what happens next. One who does not tends to fill the gap with reassurance, and reassurance is where false promises come from.
When a claim comes in, respond the same day, even if it is only to say you have the message and will call in the morning. For a family that has just had bad news, silence feels like abandonment, and it is remembered.
When you speak, explain the steps in order: what they need to do first, what you will do, what the insurer will do. Tell them which documents are needed for this type of claim, and offer to help gather them. Set expectations on time honestly. If the insurer may need medical reports that take weeks to arrive, say so now, so the family is not left wondering why nothing has happened.
Then keep them updated. A short message when the forms are submitted, when the insurer acknowledges them, and when anything is requested, means the family does not have to chase you. Hafiz's hospitalisation claim, a year after his policy started, went smoothly for exactly this reason: Wei Ling sent the forms the day he was discharged and messaged him at each step.
However sure you are, never promise that a claim will be paid. The insurer decides, based on the policy terms and the evidence. You may be confident a claim falls within the policy and still be wrong, because of a definition, an exclusion, a waiting period or a non-disclosure at application that you did not know about.
What you can promise is your part: that you will help make the submission complete, accurate and on time, and that you will keep the family informed. Say exactly that. "The insurer makes the decision, and I can't promise what it will be. What I can do is make sure everything they need is in the submission, so nothing is delayed on our side."
If a claim is declined, explain the reason as the insurer gives it, help the client understand any options to provide more information or ask for a review, and make sure they know about the complaints route covered in lesson 2.4, Complaints, conflicts and the habits that cause them, including FIDReC where it applies. Do not argue the decision on the insurer's behalf, and do not promise to overturn it.
A death claim is different from every other kind. The person who made the decisions is gone, and the people dealing with the claim may not know what policies exist, where the documents are, or even who you are.
Be patient. Families in the first weeks are dealing with funeral arrangements, relatives and their own grief. Let them set the pace for meetings, explain things more than once, and keep messages short and practical. Offer to meet in person if that helps. Do not discuss any new product during this period.
Then help them look for other policies. Kumar's daughter knew about the policy Wei Ling had arranged. She did not know about an older policy with another insurer, or about group cover through his employer. Ask the family to look through his papers for policy documents and premium notices, check bank statements for regular premium payments, and ask his employer's HR about group life cover. Check your own firm's records for any other policies he held. Remind them that CPF savings are paid out separately, according to any CPF nomination, and point them to the CPF Board for that process.
Wei Ling's help finding the second policy is what Kumar's daughter mentions when she recommends Wei Ling to her colleagues months later.
The worst time to look up an insurer's claims process is when a client is waiting for an answer. A one-page guide for each insurer you work with means you can respond with confidence on the day, and hand the family a clear list of what to do. In the activity below you build that guide for one insurer: the contacts, the documents for common claim types, and the steps in order.
Build a one-page claims guide for one insurer you work with: contacts, documents for common claim types and the steps in order.
Junxiong-WFG Organisation is an authorised representative of AIA Financial Advisers Private Limited (Reg. No. 201715016G).