The big four trauma claims







Full text


The big four

trauma claims


Important information

This information has been prepared by The Colonial Mutual Life Assurance Society Limited ABN 12 004 021 809 AFSL 235035 (CMLA). CommInsure is a registered business name of CMLA. Trauma cover forms part of CommInsure Protection. CommInsure Protection life insurance products are issued by CMLA and the superannuation product by Colonial Mutual Superannuation Pty Ltd ABN 56 006 831 983 AFSL 235025 (CMS), the trustee of the Colonial Super Retirement Fund ABN 40 328 908 469 SFN 2933/419/40 (the Fund). CMLA is responsible for the administration of the Fund and provides insurance benefits to the Fund as insurer. CMLA and CMS are wholly owned but non-guaranteed subsidiaries of Commonwealth Bank of Australia ABN 48 123 123 124. The


2 What is trauma cover?

4 Cancer

6 Stroke

8 Heart attack

10 Coronary artery bypass surgery

12 Feature: Multiple sclerosis

14 Why CommInsure?


What is trauma cover?

Trauma cover is an insurance product that pays a lump sum benefit for defined traumatic

medical conditions or events, and should form part of any risk protection portfolio. It

covers a wide range of conditions, including the ‘big four’ trauma claims of cancer,

stroke, heart attack and coronary artery bypass grafts.

Trauma cover is about survival

The media is littered with stories about more Australians suffering from lifestyle-related diseases, and unfortunately the headlines are true. Cancer rates are on the rise and the number of people with cardiovascular disease remains high.

On the bright side, medical advances are constantly improving survival rates for such conditions. But while this seems like fantastic news for trauma survivors, for some it means an ongoing battle for financial survival.

The reason? Treatment, medication, rehabilitation and ongoing financial commitments – like loan repayments – can be very costly. Combined with a reduced capacity or inability to earn an income, some survivors face financial hardship before they even leave hospital.

That’s where trauma cover can help. It eases the financial impact of trauma, paying policyholders a benefit to help with expenses like medical bills, financial shortfalls and generally help make ends meet.

In other words, trauma cover is about survival.

What are the odds?

• Overall, men have a 40 per cent risk of suffering a traumatic illness between the ages of 30-64, and 25 per cent for women.1

• By age 75, an estimated one in three men and one in four women will develop cancer.2

• Each year, an estimated 60,000 strokes affect Australians – about one every 10 minutes!2

1. Gen Re Australia 2009. Australian Critical Illness Survey 2008: a study of claims experience in 2001 to 2005.

2. Australian Institute of Health and Welfare 2010. Australia’s health 2010.

Major risk factors for common medical conditions

Disease or condition

Major risk factors for common medical conditions Tobacco

smoking inactivityPhysical Poor diet & nutrition Excess body weight High blood pressure cholesterolHigh blood

Coronary heart disease ✔ ✔ ✔ ✔ ✔ ✔

Stroke ✔ ✔ ✔ ✔ ✔ ✔

Lung cancer ✔

Colorectal cancer ✔ ✔ ✔ ✔ Source: CommInsure 2010.

What is trauma cover?

CommInsure’s Trauma cover pays a lump sum in the event of a specified medical condition, regardless of whether you are prevented from working or not. It can alleviate financial pressure in a period of intense shock and trauma, giving you and your family time to adjust to the crisis and rethink your future.


CommInsure trauma claims

Male trauma claims

Heart attack 16.6% Coronary artery bypass surgery 6.5% Angioplasty 7.2% Stroke 4.5% Other 17.4% Cancer 47.9%

Female trauma claims

Cardiomyopathy 2.9% Cancer 80.9%

Multiple sclerosis 1.5% Stroke 2.6%

Other 12.1%

Source: Gen Re Australia 2009, Australian Critical Illness Survey 2008. Source: Gen Re Australia 2009, Australian Critical Illness Survey 2008.



What is cancer?

Cancer is a condition where a normal cell (or group of cells) grows out of control. This can lead to the formation of a tumour which may continue to grow in its original location, resulting in damage to surrounding healthy cells and tissues.

If they become invasive, tumours may spread elsewhere in the body – a process called metastasis. Fortunately most cancers are now potentially curable if detected at an early stage, before metastasis occurs.

Causes and risk factors

In recent times, medical research has identified various risk factors which may specifically or collectively contribute to the onset of cancer in a given case. Some of the well-established risk factors include:

• smoking tobacco • poor dietary habits

• infectious agents (such as specific viruses) • exposure to radiation (like ultraviolet light)

• genetics (including inherited or acquired mutations). While some causes and risk factors may be mitigated through routine medical screening and specific lifestyle changes, others (such as inherited genetic mutations) remain untreatable. That said, the risk of death from specific cancers may be reduced by medically monitoring high risk people and providing the best available treatments when needed.

Source: Australian Institute of Health and Welfare 2008, Cancer in Australia – an overview.

Quick facts

• Cancer is a leading cause of illness and death in Australia. Excluding skin cancers other than melanoma, there were 104,592 new cancer cases in 2006, and 39,884 cancer deaths reported in 2007.

• One way cancer mortality can be measured is by using the five-year relative survival rate. In recent years Australia has seen overall improvements to this rate, with male survival up 17 per cent between the periods 1982-1986 and 1998-2004.

• Similarly, women’s five year survival rate improved 11 per cent over the same timeframe.

• Melanoma is a significant public health concern in Australia, which has the highest melanoma incidence rate in the world.

• As at 2006, melanoma was the fourth most common type of malignancy diagnosed in Australians.

• In 2007, 10,326 Australians were diagnosed with melanoma, causing 1,279 deaths.

Source: Australian Institute of Health and Welfare 2010, Australia’s health 2010.

How we helped

Age Occupation

Years policy

was in force Sum paid Diagnosis

49 Managing director 11 years $100K Prostate cancer 53 Homemaker 8 years $83K Uterine cancer 45 Homemaker 18 months $51K Malignant meningioma 49 IT operations 7 years $366K Prostate cancer 39 Bank officer 15 months $86K Malignant brain tumour


April’s story

Three years into her policy, April* (27) was diagnosed with Non-Hodgkin’s Lymphoma after going to her doctor

complaining of painful neck swelling. Unfortunately, April was also six months pregnant at the time of diagnosis and was unable to begin treatment until her baby was born. April’s doctors decided to induce her pregnancy at eight months to start cancer treatment, including chemotherapy. CommInsure paid April’s trauma cover benefit of $300,000, which helped meet out-of-pocket medical expenses. It also assisted with childcare costs when she was unable to care for her baby due to the side effects of her condition and treatment. * Name and other personal details changed to protect identity of client.

CommInsure’s got trauma covered

CommInsure’s Trauma product provides cover for 48 individual events, ensuring comprehensive protection for our clients. Our Trauma Plus cover goes a step further by adding an additional 10 conditions – many of which not covered by other insurance providers.

You should consider CommInsure Trauma cover if you: • have a mortgage or other debt

• have a family and associated responsibilities • have a business or business partners

• are a company director, key employee or are self-employed



What is a stroke?

A stroke typically occurs when a blood vessel in the brain is suddenly blocked or bleeds. This may cause part of the brain to die due to a lack of blood, resulting in a loss of brain function, possibly affecting limb movement, self-mobility, thought processes, vision and the ability to speak.

Blockage of a blood vessel in the brain is the most common cause of stroke, reflecting around 80 per cent of all cases. The remainder are mainly caused by bleeding in the brain, which is more likely to result in death.

Causes and risk factors

Several risk factors are associated with an increased risk of stroke, including:

• increasing age • smoking tobacco • male gender • physical inactivity • poor dietary habits • high blood pressure • raised cholesterol • diabetes mellitus

• having had a previous stroke or stroke-like event • family history of stroke or cardiovascular disease

• specific medical conditions, such as blood-clotting disorders • abuse of alcohol or illicit drugs.

Source: Australian Institute of Health and Welfare 2010. Australia’s health 2010.

Quick facts

• Stroke is a leading cause of long-term disability in Australian adults.

• As at 2003, 346,700 Australians were estimated to have suffered a stroke at some point in their lives.

• Most (70 per cent) of the 60,000 strokes that happen each year are first ever strokes.

Source: Australian Institute of Health and Welfare 2010. Australia’s health 2010. Stroke caused by blocked blood vesssel Stroke caused by bleeding How we helped

Age Occupation Years policy was in force Sum paid Diagnosis

59 Accountant 12 years $471K Stroke 25 Settlement officer 6 months $203K Stroke 47 Stockbroker 20 months $627K Stroke 50 Solicitor 4 months $1M Stroke 61 Security officer 16 years $77K Stroke

Source: CommInsure 2009-2011.

With CommInsure, 100 per cent of your Trauma Cover Benefit is automatically reinstated one year from the date your claim is paid – without further evidence of health status. This in built feature provides peace of mind that whatever the future holds, you’re covered.


Lee’s story

Lee* had smoked since his teenage years. At age 48, while watching TV at home one evening, he began to suffer breathing difficulties, a drooping effect on one side of his face and other symptoms consistent with a stroke, which was later diagnosed after being rushed to hospital.

CommInsure paid Lee’s $627,000 trauma cover benefit which helped cover his ongoing hospital costs, including intensive rehabilitation to improve his physical and cognitive functioning. * Name and other personal details changed to protect identity of client.


Heart attack

What is a heart attack?

On average, the human heart beats 70 times per minute to circulate blood around the body. Like other active muscles, the heart needs a steady supply of oxygen-rich blood to remain healthy and function properly.

A heart attack happens when one or several of the heart’s main arteries are blocked and oxygen-rich blood no longer reaches it, resulting in the death of heart cells. Such blockage is usually caused by a blood clot becoming lodged in an artery, with the clot typically arising after rupture (or tearing) of arterial plaque.

Causes and risk factors

Heart attacks are associated with several risk factors, including: • plaque build-up on the inside surfaces of coronary arteries • male gender

• smoking tobacco • raised cholesterol • high blood pressure • poor dietary habits • diabetes mellitus

• family history of heart disease.

Fortunately, most of the above risk factors can be managed through positive lifestyle changes and various medical therapies. Source: Australian Institute of Health and Welfare 2010. Australia’s health 2010.

Quick facts

• Coronary heart disease kills more Australians than any other condition. In 2006, it resulted in 22,983 (or 17 per cent) of all deaths reported that year.

• However, decreasing death rates have been reported since the 1970s. During the period from 1996 to 2006, age-standardised death rates fell by 45 per cent in males and 44 per cent in females.

• Coronary heart disease is more common in men than in women.

• Coronary heart disease becomes more common with age. In Australia, 7.5 per cent of people aged 55-64 are affected, compared with over 20 per cent of those aged 75 and above.

Source: Australian Institute of Health and Welfare 2010. Australia’s health 2010.

How we helped

Age Occupation

Years policy

was in force Sum paid Diagnosis

40 Teacher 5 years $137K Heart attack 56 Contractor 24 months $115K Heart attack 52 Lab technician 12 months $50K Heart attack 58 Manager 24 months $473K Heart attack 49 Workshop foreman 8 years $39K Heart attack


Angelo’s story

At the age of 51, Angelo* underwent a single-vessel angioplasty procedure on the recommendation of his cardiologist. Following his procedure, Angelo submitted a claim for a partial trauma cover benefit specific to the single-vessel angioplasty

procedure, which reflected 10 per cent of his total sum insured. However, upon reviewing his claim, CommInsure’s Claims team discovered that his medical records actually reflected that Angelo had also suffered a heart attack (as defined in his trauma cover policy) prior to his angioplasty procedure. Although Angelo and his treating doctors had not specifically noted the heart attack in his claim documents, CommInsure paid Angelo his full sum insured of $277,000, which reflected the heart attack trauma benefit.

Even if Angelo had not suffered the heart attack, CommInsure would still have paid his partial benefit of $27,700, following his single-vessel angioplasty procedure.


Internal mammary artery graft Saphenous

vein graft

Coronary artery bypass surgery

What is a coronary artery bypass graft?

Coronary artery disease is diagnosed when someone has narrowing of one or more of the coronary arteries that supply oxygenated blood to the heart. As the disease progresses and arteries continue to narrow, blood flow to the heart decreases which can ultimately result in the damage or death of heart cells. A coronary artery bypass graft (CABG) is a surgical procedure to bypass a blocked artery and provide an alternate pathway for blood to reach the heart. The CABG procedure typically involves open-chest surgery, where the surgeon removes a section of donor vein from elsewhere in the patient’s body and connects it above and below the site of arterial blockage, thereby bypassing it.

How we helped

Age Occupation Years policy was in force Sum paid Diagnosis

61 Insurance adviser 6 years $103K CABG 52 Trucking contractor 8 years $126K CABG 41 Manager 24 months $527K CABG 61 Solicitor 6 years $1.14M CABG 64 Retiree 5 years $237K CABG

Source: CommInsure 2009-2011.

CommInsure’s Trauma cover at a glance

At a glance

Stepped premium rate Minimum entry age 17 Maximum entry age 62 Level premium rate Minimum entry age 17 Maximum entry age 54 Maximum cover $2,000,000

Maximum child cover $100,000

Cover combinations Stand-alone Trauma Trauma and Life Care Trauma, TPD and Life Care Trauma and TPD

Available in super No

Quick fact

• In Australia, a total of 41,826 CABG procedures were performed in 2007-08.


Arthur’s story

A smoker since age 18 and with a strong family history of heart disease, Arthur* (now 45) was diagnosed with coronary heart disease by his doctors.

Eight months before submitting a trauma claim for coronary bypass surgery, Arthur started experiencing an increasing number of episodes including shortness of breath and chest discomfort. He later required coronary artery bypass grafting to four narrowed arteries – a quadruple bypass.

While recovering from surgery and shortly after submitting his trauma claim to CommInsure, he received payment of his full sum insured, $1.4 million. This payment enabled Arthur to take more time off work and focus on his continued recovery. * Name and other personal details changed to protect identity of client.



Multiple sclerosis

What is multiple sclerosis?

Although not as common as the other conditions mentioned here, Multiple sclerosis currently affects around 18,000 Australians. MS is a progressive disease of the central nervous system, for which there is currently no cure. Over time, the nerve cells in people with MS lose their myelin coating, which acts like insulation on electrical wiring. As this myelin is destroyed it is replaced by scar tissue, which causes the delay or blocking of nerve impulses to and from the brain. The resulting symptoms vary depending on the location of damaged nerve cells. Early signs and symptoms of MS include blurred vision, numbness in the hands and/or legs, generalised weakness and fatigue, together with a loss of coordination and balance. Typically the disease worsens with time, often leading to symptoms such as loss of vision, bladder/bowel problems and paralysis.

Causes and risk factors

• MS is not a contagious condition.

• MS is not thought to be hereditary, but genetic susceptibility does appear to play a part in its development.

• The incidence of MS increases in countries located further away from the equator.

Source: MS Australia, 2010.

Quick facts

• The underlying cause(s) of MS remains unknown. • It is around twice as common in women as men and can

affect people as early as age 20.1

• It’s estimated that 2.5 million people suffer MS globally, including some 18,000 Australians.2

1. Mayo Clinic, United States, 2000. 2. MS Australia, 2010.

How we helped

Age Occupation

Years policy

was in force Sum paid Diagnosis

46 Registered nurse 10 years $101K Multiple sclerosis 38 Homemaker 11 years $132K Multiple sclerosis 50 Mobile phone technician 12 months $240K Multiple sclerosis 58 Environmental scientist 6 years $56K Multiple sclerosis 43 Homemaker 3 years $109K Multiple sclerosis

Nerve cell

Loss of myelin coating in MS


What is provided under CommInsure’s Trauma cover?

Benefits Trauma benefit

Partial trauma cover benefit Buy back benefit

Severe hardship booster benefit Financial planning benefit Loyalty bonus benefit Accommodation benefit Indexation

Interim accident cover

Optional extras

Trauma plus cover option Evidence of severity

Guaranteed insurability (personal events)* Guaranteed insurability (business events)* Business safe cover

Child cover option

* Only available for a policy with Life Care.

For details on the benefits and optional extras listed here, please refer to the CommInsure Protection product disclosure statement.

Emma’s story

Five years after taking out her trauma cover with CommInsure, Emma* (39) submitted a claim for progressive multiple sclerosis, after her neurologist confirmed diagnosis.

Medical imaging revealed Emma’s brain and spinal cord were becoming increasingly affected by the disease, with her symptoms progressing to the extent that she had problems walking. She had also suffered more than one episode of such symptoms before submitting her claim.

CommInsure paid Emma a full trauma benefit of $369,000 which, among other expenses, helped modify her family home to make it safer to move around with increasing physical impairment.


Why CommInsure?

CommInsure is a leader in the Australian Insurance industry. We offer a fresh approach to

personal risk insurance, backed by a strong history – as one of Australia’s largest life risk

insurers, with over three million clients and more than 135 years experience.

CommInsure’s financial strength and claims capability provide peace of mind to policyholders. CommInsure’s claims philosophy is simple: we pay all genuine claims promptly and efficiently. Our claims history substantiates our adherence to this philosophy.

In 2010 we paid a total of $609 million* in life and disability insurance claims. In that year we paid over 570 people $89.3 million to help with a serious trauma or permanent disability.






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