All insurance parties would benefit from a focus on recovery and wellness rather than claims eligibility, the Actuaries Institute believes.
The Actuaries latest green paper on mental health and insurance found that the insurance sector faced systemic difficulties dealing with mental health coverage, despite the fact that one-in-five Australians aged over 15 would be affected by a mental health condition in any 12-month period.
It found that problems with insurance could arise at three different touch points between consumers and the insurance product – product design and definitions, buying or entering an insurance product, making a claim and receiving benefits or payments.
The Actuaries Institute president, Jenny Lyon, said while there had been some recent substantial changes in insurance cover for people with mental illness, specifically the removal of blanket exclusions from some travel insurance policies, all parties would benefit from a focus on recovery and wellness, rather than claims eligibility.
“There is an opportunity for doctors, life insurers and employers to work together for better outcomes,” Lyon said.
“Insurers and doctors want the same outcome: a return to health for the patient or the consumer. Change needs the support of the industry, medical professionals, policy makers, consumers, and their advocates.”
The paper said the sector should support early intervention to deal with mental health conditions, focus on providing the best treatment to reduce recovery times, and increase the likelihood that consumers can return to work.
It also found that the prevalence of mental injuries in workers compensation was greater in public employees than in the private sector.
However, it also found that many insurers were improving claims processing, progress was hampered by insufficient data and subjective criteria for diagnosis, the claims process could e adversarial and could lead to secondary mental harm, there was a bias against early intervention that could hinder a claimant’s recovery and returns to work, and insurers faced real challenges to sustainability.
