Insurance And Emergency Management

Types of Insurance

Discuss about the Insurance and Emergency Management.

It is important for an insurance agent like me to sell the products of my organization. It is of primary importance to primarily have knowledge about all the products, which are available for sale. Every insurance agent has a target to complete within a stipulated time span and therefore, I had to approach various clients to offer him or her insurance products. One of such persons whom i had approached was Mr Malcolm Johnson who is currently employed at ACME Pvt Ltd. He is married for over twenty-six years to Mrs Susan Johnson who is even working as an accountant in Phone r Us Ltd. They have a son and a daughter who are currently working their way through college. It is very important for every person to get their life insured to protect their family from any unprecedented accidents. There are various types of insurance like life insurance, money recovery insurance, flexible recovery money insurance, income daily living insurance, additional money insurance, health insurance etc. There are certain insurances like health insurance, which is very crucial for every person to purchase so that insurance can be claimed in case there is a serious illness. In case of a fire or natural disaster, the insurance can be the difference between the having a normal life and from going bankrupt. Depending on the type of policy, insurance can replace the income lost and restores the property destroyed. The life insurance policy covers the life assured and offers monetary compensation due to death of the insured during the term of insurance. The health insurance policy on the other hand gives compensation during any health mishap and recovers the money lost for the medical expenses. The disclosures, which needs to to be presented by Mr Malcolm are his personal information with respect to health, personal property, financial assets, financial information etc.

The variety of insurance products discussed earlier is all available for sell by the company under which I work. The information about Mr Malcolm was available to me through a close relative who said that Mr Malcolm is in need of insurance and requires someone from whom he can take help and gather the decision about purchasing the relevant insurance product. The relative gave the phone number to me after which I contacted him. He said that he was interested in having a meeting with me regarding the insurance perspective and it was decided that I was to meet him at his house on Sunday, 17/02/2013 at 6 pm in the evening. In order to provide efficient information to Mr Malcolm, I prepared myself by getting to know all the features of the insurance, which are available for me to sell. I even prepared an interview questionnaire so that all relevant information with respect to his information and his preferences could be gained. On the day of the meeting, I reached his premises on time and found that he was eagerly waiting for me. He offered me a cup of tea and wanted to know about my experience with respect to insurance and some personal information. After a formal interaction with him, we started our professional conversation.

Meeting with Mr. Malcolm

The primary question I asked him was the type of insurance he wanted. It came to knowledge that it is his first insurance and he does not have any knowledge about insurance and its varieties. Mr Malcolm was given a brief knowledge about the benefits of insurance and then detailed information was given to him about all the products insurance and which are the products that are suitable for him to purchase.  It was seen that Mr Malcolm wanted a security for his family in case anything happened to him and therefore, he was offered with a life insurance product with a term of 15 years, which provided that a certain amount of money will be given to his family if Malcolm expires within the duration of the insurance. Malcolm was even concerned about his growing age and thought that with age he would be lingered with illness. The concern was a justified one as it is known that sickness arises with age. Thus, another health insurance product was given to him where he had to pay a premium annually. The benefit of this insurance is that during the time of any serious or critical illness, the insurance would provide him monetary benefit thereby restoring his money, which will be lost to cure the treatment. A question was asked to Mr Malcolm asking whether he was in need of any extra income and it was seen that he was interested in gaining some extra income. Therefore, another insurance product was offered to him known as the income protection plan where his money would be protected in case of any accident. This plan would even provide a monthly interest, which would act as an extra income for him. Mr Malcolm was satisfied with the products that were offered to him. A detailed explanation about all the insurance products cleared off his mind and now he had a clear idea of which products to choose according to his preference.

I was successful in convincing Mr Malcolm about the benefits of insurance and was sure that he would be purchasing at least one product from me. Mr Malcolm was a bit concerned about the amount of money he had to invest yearly, as this would reduce his income level. I assured him of the fact that the amount invested will act as his asset as it would protect his life, health and income. The insurance cover would even provide him with an interest that will act as an income from him. I explained him that insurance might be loss in the short-run but will become an asset for him in the end. It will become a fixed income during his time of retirement. The interview with Mr Malcolm was satisfactory and it was seen that he is a very polite and patient person who listened carefully about all the products that I explained him. He was quick to ask any questions that came into his mind and always enquired any queries that rose in his mind.

Lessons Learned

As I was new in the field of insurance, in the beginning I was a bit nervous while interacting with him and stammered a bit when he asked me questions about his queries. He understood that I was a bit nervous and tried to relax me by talking a bit informally and asking me to take help of the product brochures to rectify the queries that he had. I even asked him questions about his personal income and his assets and liabilities so that a clear idea can be gained to provide the necessary products that will be ideal for Mr Malcolm to purchase.

After the completion of the meeting, Mr Malcolm decided to purchase three insurance products from me namely a life insurance product, a health insurance product and an income protection insurance plan. The meeting with Mr Malcolm has given me a lot of knowledge about the mistakes I have made and it is seen that from the next time onwards I need to gain confidence while having a conversation with the clients and need to understand the queries of the clients properly so that it can easily be resolved. It is even essential for me to have a proper knowledge of the products and need to understand the obligations of the customers and offer them with the products that are ideal for them. The above meeting with Mr. Malcolm has given me immense confidence and this will be helpful in bringing about improvements in me when interacting with other clients.

	Excellent	Very Good	Good	Fair	Poor
Preparation for interview ·         Initial contact and setting up of meeting ·         Did the student clearly advise you of the requirements of the interview?	ü
Student’s explanation of ·         Duty of disclosure ·         Life insurance ·         Total and Permanent Disability ·         Critical illness/ trauma insurance ·         Income protection      !                       "            #               $!		ü
Interview ·         Student’s preparations for the meeting?( room set up, papers in order, had everything they needed, etc) ·         Student’s knowledge of the insurance application form being completed? ·         Student’s knowledge of the insurance product. ·         Student’s ability to satisfactorily answer your questions? ·         Student’s communication skills		ü
Overall Comments ( Please provide the student with any positive feedback, constructive criticism and suggestions for improvements) The interview undertaken by the student was organized properly and orderly and the student provided an extensive discussion about the insurance products. The student needs to gain some experience and needs to overcome the tension as once a tricky question is asked he stammers but ultimately gains his confidence to answer back and explain properly. The student is competent in attracting clients and convincing them but just needs to overcome his nervousness and tension.

Mr Malcolm is not quite comfortable to reveal his personal information to the insurance company. He feels disclosing his personal information related to income, health and address might disturb his security and safety. This is the reason why a proper explanation needs to be provided to him so that he feels safe in disclosing his information.

The insurance company needs the personal information of its clients because insurance organization relies upon the premium it charges for life and health insurance products on the basis of mortality and the morbidity rates of the population insured. The rate of premium is calculated by using the mortality tables and experience on claims (Smith 2013). Therefore, it is essential for the customer to provide its information about age and health so that an idea can be attained for the calculation of the premium rate for the insured person. The lives of the insured are underwritten at the organization’s standard rate if their potential mortality is not greater than the average age of the population. The people insured who have health issues or is of old age needs to pay higher premiums as the risk associated to them are higher. A detailed information in the application form will enhance the processing of the insurance for the clients and it will be easier for the organization to calculate the premium to be levied on the client’s insurance premium. The information will be easier for the organization to understand the health condition thereby calculate the rate of risk associated with him. The financial information is helpful in recognizing whether the client will have the ability to pay the premium every year till the duration of the insurance (Sadgrove 2016). The information about their residential address is essential for the company as it will be easier for them to send any important documents to the client through courier or mail. The contact information is essential for connecting with the client if needed. Mr Malcolm has been given assurance about the security of his personal information as the company has an efficient database with a secured firewall system to restrict any sort of hacking or release of this information.

Preparing for an Interview

This is to inform you that with respect to your query regarding the process of the purchase of the product, I would like to inform you that it is an easy process where all the information regarding the product will be discussed in detail and the documents required to be submitted will be mentioned in the brochure of the product. On the time of discussing the product, a detailed explanation will be given about all the products to help select the product of their choice. The rate of premium, the duration of the insurance, the total sum assured along with any death benefits will be clearly mentioned in the brochure of the product. The detailed information about the variety of products will be helpful to you in deciding which product is suitable. After the purchase of the product, all the documents related to the insurance product will be sent to you through email and by courier to help you keep a record of the product. The documents, which will be sent to you will comprise of the receipt of payment of the product, a statement showing the duration of the insurance and the premium rate to be paid annually. It also includes customer care assistance number, the terms and conditions of the insurance, penalty amount if unable to pay, a detailed breakdown of the total sum assured and the benefit you will from the insurance product. these documents will be essential for you as it will keep a record of the purchase and in time of any discrepancy, you can look down on the terms and conditions and make necessary claims.

It is therefore, essential that these process are undertaken as it will be helpful to you and will even provide a customer protection to you. I hope this letter will help you in clarifying all the queries that you had in mind. If you have any other query, kindly revert a mail to me so that I can clarify your doubts with ease.

The Financial Ombudsman Service provides clear, independent and approaches discrepancy resolution for the clients who are unable to solve complaints with members of the financial service providers.

It is a non-profit and private organization that rectifies disputes swiftly and effectively and thus is an economical alternative rather than approaching the court. The service they provide is free of cost for the applicants with the cost  of continuing the service is undertaken by the members.

Explanation of Insurance Types

The members mentioned here constitutes of banks, credit providers, financial consultants, debt agencies, insurers etc who provides financial services and products.

The FOS provides the service of solving discrepancies between the financial service providers and the clients in a cooperative, effective, fair and timely manner. The service is done with minimum formality and technicality and provides the service a clearly as possible, taking into account the accountability for privacy and confidentiality. The role even involves the having knowledge about all the components of a dispute without taking any sides and making decisions on the basis of some specific logics and circumstance of individual disputes (Lam 2014).

By analyzing the role of the Financial Ombudsman Service it is easier to analyze the the case study, which will be discussed below:

The following case study refers to a dispute that has risen between an Applicant of a critical illness benefit under a policy taken from a Financial Service Provider (FSP). The main outline of the vital components of the case between the Applicant and Financial Service provider (FSP) is that after a few days of purchasing the policy, she suffered a heart attack for which she had to be admitted to the hospital. After recovering from the heart attack she claimed to her provider for the compensation for her heart attack. It is seen that after reviewing her reports the financial service provider denied her claim saying that her heart attack was not critical with respect to the terms and conditions laid down in the policy. It is seen that according to the policy, a claim will only be approved for a heart attack if the heart attack is termed critical that is any irregularities are caught in the Echocardiogram tests or there is a massive change in the cardio-enzyme level in the heart. An increase in the Troponin level to more than 2 micro-grams is even an indication that it is a sign of a severe heart attack (Department of Health 2013). After examining the results of the echocardiogram, the service provider has seen that there are no irregularities present and the Troponin level has not increased over 2 micro-grams and therefore her claim is not justified for approval.

The Applicant on the other hand is satisfied with the claim denial process and has filed a case in the Financial Ombudsman Service saying that nothing with respect to the severity of the heart attack was mentioned in the policy conditions and she signed the policy with the idea that she would get a claim in case of any sort of heart attack. The applicant has even complained that even if there were any clause stated with respect to the heart attack, the words used in explaining the sentence is very difficult for any layman to understand as the words are financial and contract related, which are not easily understood by the common man. She feels that the policy terms are unfair (Omarova 2012).

The FOS after examining the documents presented from both the parties finds that the service provider’s claims are justified and thus passes the judgment in favour of them.

The financial service provider wished to deny the claim because it was clearly stated in their policy that only in case of any critical illness would the applicant get any claim for them  policy. In case of heart attack, a clause was given that a heart attack identified through an echocardiogram test or an increase in the cardio enzyme or troponin level to over 2 micro-grams will be treated as a severe heart attack. The documents presented by the applicant showing the doctors report and the echocardiogram report show no indications of a heart attack and therefore, claim was denied by the financial service provider as the claim was unjustified in the eyes of the provider (Tarr and Finn 2012). Any documents revealing the claim of a heart attack would have been enough for the approval of the claim.

The applicant believed that she deserved to be paid by the financial service provider because the terms and conditions of the policy were very complex for any common person to understand and there was no clause in the policy that stated clearly that the claim will only be approved if the heart attack is confirmed through an echocardiogram or changes in the cardio enzyme and increase in Tropinin level to over 2 micro-grams. She feels that the terms of policy are unfair and therefore it is her right to receive the claim. The contract agreement is prepared by the service provider and they prepare the agreement papers according to their ease and thus they use such terms and words with respect to law and finance, which are difficult for people like to understand, and thus feels that the policies are unfair and requests the FOS to give their judgment on behalf of her as she was cheated by the service provider (Mills and Haines 2015).

According to the current case, it is felt that the conduct of the FSP is justified because the even if it is assumed that they have prepared the terms and conditions in the policy agreement according to their own wish, it is the responsibility of the applicant to go through the policy in detail and ask the providers for clarification with respect to any queries she has. She can even take help of a solicitor to understand the terms and conditions of the policy. If the policy was unfair to her she could have terminated the contract before it started.

The conduct of the applicant is not justified as she could not provide any documents that shows relevancy to her heart attack and she went into a contract with the financial provider without understanding the meaning of critical illness. She could have taken help of a solicitor or even asked the provider about the terms of policy if she had any doubt but as she has signed the agreement she has no power to claim for the approval (Buck and Kirkham 2016).

The determination given by FOS is justified as they will look upon the documents provided by the two parties. It is seen that the documents given by the service provider reveals the actual meaning of critical illness and reveals that only increase in the cardio enzyme or rise in the Troponin level to over 2 micro-grams or irregularities reported in the echocardiogram will be  considered as a critical heart attack. But the documents provided by the applicant show no such reports and therefore according to the policy the applicant is not liable for a claim. It was the responsibility of the applicant to understand the terms before signing it and once she has signed it any claims not justifying the policy terms will not be accepted.

Reference List

Buck, T. and Kirkham, R., 2016. The ombudsman enterprise and administrative justice. Routledge.

Department of Health, 2013. Patients First and Foremost: The Initial Government Response to the Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Vol. 8576). The Stationery Office.

Lam, J., 2014. Enterprise risk management: from incentives to controls. John Wiley & Sons.

Mills, A. and Haines, P., 2015. Essential strategies for financial services compliance. John Wiley & Sons.

Omarova, S.T., 2012. Bankers, bureaucrats, and guardians: Toward tripartism in financial services regulation. Journal of Corporation Law, 37(3).

Sadgrove, K., 2016. The complete guide to business risk management. Routledge.

Smith, K., 2013. Environmental hazards: assessing risk and reducing disaster. Routledge.

Tarr, A. and Finn, D., 2012. Implementing Universal Credit: will the reforms improve the service for users. Centre for Economic and Social Inclusion, York: Joseph Rowntree Foundation.

Australia, S.W., 2012. Compendium of Workers¿ Compensation Statistics Australia 2009¿ 10. Australian Government-Safe Work Australia.

Blackwell, D.L., Lucas, J.W. and Clarke, T.C., 2014. Summary health statistics for US adults: national health interview survey, 2012. Vital and health statistics. Series 10, Data from the National Health Survey, (260), pp.1-161.

Carter, R.A., 2012. Flood risk, insurance and emergency management in Australia. Australian Journal of Emergency Management, The, 27(2), p.20.

Cohen, R.A. and Martinez, M.E., 2012. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January–March 2012. Atlanta, GA: Centers for Disease Control and Prevention.

Cohen, R.A. and Martinez, M.E., 2014. Health Insurance Coverage, Early Release of Estimates from the National Health Interview Survey, 2011. National Center for Health Statistics.

Cummins, D. and Santomero, A. eds., 2012. Changes in the life insurance industry: Efficiency, technology and risk management (Vol. 11). Springer Science & Business Media.

Dumas, M., La Rosa, M., Mendling, J. and Reijers, H.A., 2013. Fundamentals of business process management (Vol. 1, p. 2). Heidelberg: Springer.

Gilad, S. and Yogev, T., 2012. How reputation regulates regulators: Illustrations from the regulation of retail finance. The Oxford Handbook of Corporate Reputation, p.320.

Glendon, A.I., Clarke, S. and McKenna, E., 2016. Human safety and risk management. Crc Press.

Heazle, M., Tangney, P., Burton, P., Howes, M., Grant-Smith, D., Reis, K. and Bosomworth, K., 2013. Mainstreaming climate change adaptation: An incremental approach to disaster risk management in Australia. Environmental science & policy, 33, pp.162-170.

Hull, J., 2012. Risk Management and Financial Institutions,+ Web Site (Vol. 733). John Wiley & Sons.

Kumar, A. and Yao, W., 2012. Design and management of flexible process variants using templates and rules. Computers in Industry, 63(2), pp.112-130.

Martinez, M.E. and Cohen, R.A., 2012. Health insurance coverage: early release of estimates from the National Health Interview Survey, January–June 2010. National Center for Health Statistics. December.

McLennan, B.J. and Handmer, J., 2012. Reframing responsibility-sharing for bushfire risk management in Australia after Black Saturday. Environmental Hazards, 11(1), pp.1-15.

McNeil, A.J., Frey, R. and Embrechts, P., 2015. Quantitative risk management: Concepts, techniques and tools. Princeton university press.

Melecky, M. and Podpiera, A.M., 2013. Institutional structures of financial sector supervision, their drivers and historical benchmarks. Journal of Financial Stability, 9(3), pp.428-444.

Navarro, A.E., Gassoumis, Z.D. and Wilber, K.H., 2013. Holding abusers accountable: An elder abuse forensic center increases criminal prosecution of financial exploitation. The Gerontologist, 53(2), pp.303-312.

Rosemann, M. and vom Brocke, J., 2015. The six core elements of business process management. In Handbook on Business Process Management 1 (pp. 105-122). Springer Berlin Heidelberg.

Sabatino, S.A., Thompson, T.D., Richardson, L.C. and Miller, J., 2012. Health insurance and other factors associated with mammography surveillance among breast cancer survivors: results from a national survey. Medical care, 50(3), pp.270-276.

Schiller, J.S., Lucas, J.W., Ward, B.W. and Peregoy, J.A., 2012. Summary health statistics for US Adults: National health interview survey, 2010. Vital and Health Statistics. Series 10, Data from The National Health Survey, (252), pp.1-207.

Suriadi, S., Wynn, M.T., Ouyang, C., ter Hofstede, A.H. and van Dijk, N.J., 2013, June. Understanding process behaviours in a large insurance company in Australia: A case study. In International Conference on Advanced Information Systems Engineering (pp. 449-464). Springer Berlin Heidelberg.

Weske, M., 2012. Business process management architectures. In Business Process Management (pp. 333-371). Springer Berlin Heidelberg.