Client Story · Claims Advocacy •
Claims advocacy that made a difference: helping Michelle secure the income protection she deserved
Michelle’s insurer approved her income protection claim — then paid a fraction of what her policy promised. Here’s how claims advocacy secured the full benefit she’d been paying for.
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Michelle came to us at a time when she was already dealing with enough. A business owner in her early 40s, she’d been forced to step away from work due to a serious health condition. Thankfully, she had an income protection policy in place and expected her insurer to support her during recovery. But when her claim was approved, something didn’t feel right.
- Her insurer had approved the claim but was paying only a fraction of the benefit her policy schedule stated.
- We reviewed the policy wording, the schedule and the insurer’s calculation — and analysed her business financials and income history.
- We raised a formal dispute and escalated it, presenting a clear financial case.
- The insurer revised the claim to a significantly higher monthly benefit, in line with the cover she’d paid for.
- Michelle now has financial breathing room and peace of mind to focus on her recovery.
The problem: an approved claim that didn’t add up
Despite having a policy schedule that clearly stated a significantly higher monthly benefit, the insurer was paying only a fraction of that amount. Michelle couldn’t understand why — and when she tried to ask questions, she was met with confusing explanations and conflicting figures. That’s when she reached out to us.
How we built the case
We reviewed her policy wording, the original schedule, and the insurer’s benefit calculation. We also went deeper — analysing Michelle’s business financials, historical income patterns, and the supporting documents used in the claim. The numbers didn’t add up, and we knew it.
Using our expertise in policy interpretation and claims advocacy, we contacted the insurer, raised a formal dispute, and escalated the issue. We presented a clear financial case showing that the insurer’s initial calculation was not aligned with the terms of the policy or Michelle’s actual pre-disability income.
If an insurer’s claim calculation doesn’t match your policy, you don’t have to accept it at face value. We can review the wording and the numbers, and go into bat for you — from our Bundoora practice and Australia-wide by video.
Book a free consultationThe result: the payout she was entitled to
After ongoing negotiations and persistence, the insurer agreed to review and revise the claim. The result? A significantly increased monthly benefit — bringing the payout in line with the cover Michelle had been paying premiums for all those years.
Today, Michelle doesn’t have to worry about her finances while she focuses on her recovery. She has financial breathing room, the confidence that her income is protected, and peace of mind knowing someone went into bat for her when it mattered most.
Why claims advocacy matters
For us, it’s more than just advice — it’s about standing by our clients when they need it the most.
Manny is a Melbourne-based financial adviser specialising in superannuation, retirement planning and Centrelink strategy for Australians in their 50s and 60s. Over more than 17 years and a thousand retirement plans, he’s found that what people want isn’t a bigger number — it’s the confidence that they’ll be okay. He works with clients across Melbourne’s northern suburbs from Plan My Wealth’s Bundoora office, and Australia-wide by video.
+61 433 564 003 · manny@planmywealth.com.au · Book a free consultation
