Is there a market for reverse insurance claim specialists?

I’m writing this article after returning from Cathie Chew’s “Get RAW! With A REAL Agent” book launch as I have a few insights from Cathie’s sharing of her life experience in her book launch.

This is Cathie’s 4th book and also the 8th year after the raw fish saga in 2015 that caused her husband to lose his hearing. The incident also transformed Cathie’s career where she left her financial consultant career of more than 2 decades to become a caregiver for her husband.

It is also the same incident where Cathie had to go through lengthy claim processes, often having to challenge and provide supplementary documents to reverse claim rejections for some of the insurance policies that her husband had bought when he was healthy.

Not surprisingly, the most challenging ones are the group insurance policies that her husband has with the company he worked in.

Here are some of the takeaways that I have learn from the book launch.

HR is often inadequate in assisting with complex insurance claims

The HR department in the organisation has a myriad of responsibilities ranging from administration, compensation and benefits, training and development, performance management, etc.

Group insurance is just one of the many benefits that the HR department facilitates as a benefit that the organisation offers to employees. In the entire career of a HR professional, it is possible that one may not have to assist with even one insurance claim for an employee.

This means that if the employee’s insurance claim is rejected by the insurer, the HR professional is unlikely to be able to provide further assistance in reversing the claim decision made by the insurer.

Insurance agents may not have the knowledgable to assist with complex insurance claims

While most insurance agents are educated on how they can facilitate and assist with their clients’ policy claims, most of the training is designed to train insurance agents to help the client to process the insurance claims with the relevant documents.

What I interpreted from Cathie’s sharing and her response during the AMA (Ask Me Anything) was that insurance agents may not be that knowledgable to help process complex insurance claims and they may not know what they need to do to reverse claims rejections. 

Insurance agents are still salespeople who have sales targets to meet

I’m sure that insurance agents will hate me for writing this, but we need to remember that insurance agents are still salespeople in the insurance industry and they have sales targets to meet. As self-employed individuals who are remunerated by commissions from the insurance policies they sell, insurance agents have to focus on generating insurance sales.

For complex insurance claims like Cathie’s husband’s case that spanned across a number of years, it is not realistic to expect insurance agents to dedicate much of their time to help you challenge and reverse claim decisions.

Insurance agents ultimately represent the insurer and there are limitations

When engaging insurance agents, we cannot forget that insurance agents represent the insurer and are compensated by the insurer. How likely is your insurance agent willing to challenge the claim decision and try to reverse the decision made, at the risk of biting the hand that feeds them?

I leave that for you to think about.

This is not to say that insurance agents are bad or that they do not work towards your interest, but I would think that they have their limitations in helping to reverse claim decisions, especially for complex claims.

Is there a market for reverse insurance claims specialist?

In Cathie‘s journey to reverse the insurance claim rejections her husband encountered in some of his insurance claims, she has accumulated a wealth of experience that allowed her to create a new career for herself – “Reverse” Insurance Claim Specialist.

Using her knowledge, Cathie now helps her clients reverse claim rejections and is remunerated with a percentage of her clients’ successful claim.

While one would wonder, why should I pay someone to reverse claims, I would like to think of this as a win-win for both Cathie and her clients who otherwise would receive nothing from the insurer. Don’t forget that we are talking about complicated insurance claims that the common people are not able to get insurers to reverse.

Cathie also shared that there are many cases where insurance agents would refer their clients to Cathie to assist with reverse claim rejections. My opinion is that Cathie should charge these insurance agents a fee for helping their clients because this takes distressed clients away from the agents, allowing them to focus on sales.

So all in all, do you think there is a market for reverse insurance claims specialists?

Would you hire a reverse insurance claims specialist if your claim is rejected?

Share your thoughts in the comments section below.