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Closing the trauma gap in critical illness cover

Posted on 13 Aug, 21 by BrightRock

Closing the trauma gap in critical illness cover

BrightRock launched the patented Trauma IQ assessment as a world-first in 2015 to cater for those additional expenses that arose from accidental injuries, yet do not meet traditional critical illness criteria. In 2020, more than half of BrightRock’s additional expense needs claims on its individual life product were Trauma IQ claims. These claims would not have been covered without Trauma IQ.

Trauma IQ broadens the scope of additional expense needs cover, or as it’s known in the market, critical illness cover, to take into account the impact of a trauma event on members’ lives. For group risk schemes, Trauma IQ can also be included with members’ death cover. This gives them cover for injuries that result in unexpected expenditure, even if the scheme hasn’t selected additional expense needs cover.

Trauma IQ considers factors overlooked by traditional assessment criteria

Industry claims statistics show that trauma and accidental injury are among the leading causes of life insurance claims in South Africa. Traditional assessment criteria focus on the diagnosis of a member’s condition, or on the specific procedure done to treat their condition. However, even with these criteria, several scenarios still exist where members’ trauma claims don’t qualify for a pay-out, regardless of the number of conditions they cover.

BrightRock’s claims experience and in-depth analysis found that traditional assessment criteria often don’t consider certain factors when it comes to the additional expense needs claims of members who have suffered a traumatic injury. Even though members’ conditions might not meet these traditional claims criteria, they might still have incurred substantial additional expenses, such as hospitalisation, surgery and significant rehabilitation. Trauma IQ caters for these overlooked factors.

A case study: pay-out for a broken ankle

In 2020, a BrightRock client, aged 45, submitted a claim for Trauma IQ after breaking her ankle while jumping on a trampoline at her child’s birthday party. The break was very bad and she had to spend some time in hospital, undergoing extensive surgery and physiotherapy to make sure that she healed properly. The combination of these factors resulted in a pay-out of 7.5% from her additional expense needs cover, which she would not have qualified for with any other provider. She could use this pay-out to assist with additional expenses that she now had, such as an ehailing service to transport her and her children as she couldn’t drive for some time.

Evaluating the impact of a trauma event using consistent guidelines

The patented Trauma IQ assessment looks at nine different factors that affect the impact and severity of a traumatic injury. Each element is assigned a number of points, which are combined to provide an overall Trauma IQ score. The maximum number of points that can be assigned to each factor varies per factor because the impact the factor has on a member’s health and financial needs will vary.

The member’s pay-out is calculated based on their Trauma IQ score

Once the member’s score for each element has been determined, the Trauma IQ assessment adds together their scores, taking into account any cross-factors. This score maps to a set pay-out percentage based on the overall severity and impact, as determined by the Trauma IQ assessment.

The pay-out is calculated as the Trauma IQ pay-out percentage multiplied by the maximum cover amount – that is, the lower of the additional expense needs cover amount or a percentage of death cover amount (whichever the scheme has included), or the maximum Rand amount applicable to the scheme.

A needs-matched approach to group risk

BrightRock’s group risk solution means your group risk scheme’s members get claim certainty and flexible insurance that offers more cover for the same premium. It’s a very different approach, delivering group risk cover that precisely matches members’ needs.

This article was originally published on EBNet on 13 August 2021 and is attributed to Clyde Parson, BrightRock Chief Innovation Officer. Click here to read the original online version.

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