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Accepted
Eric^, a 60-year old from Victoria, applied for Life cover only. On his application he reported a history of long-term Post Traumatic Stress Disorder (PTSD) relating to previous military service, a condition that would usually attract a 100% premium loading.
The challengeEric’s underwriter David was unable to find any medical records on Kevin’s condition. The trigger event happened overseas many years ago and Eric’s Australia-based psychiatrist had recently retired.
Our decisionIn an effort to find a solution, David asked whether Eric would be comfortable providing further information via tele-underwriting. Eric agreed and David spoke with him about the severity and frequency of his PTSD symptoms. This conversation gave David comfort that Eric could be offered Life cover at standard rates, without any premium loading.
Amended
Suresh^, a 33 year old from Western Australia, applied for Life and Trauma cover with OnePath. Based on his application, our underwriter James noted Suresh had a high Body Mass Index (BMI) of 37. A subsequent medical exam confirmed his BMI to be 37.6, but it also revealed elevated blood pressure.
The challengeAs a result of these additional risk factors, Suresh’s was offered Life Cover with a 100% premium loading and Trauma Cover with a 125% premium loading. James also invited Suresh to be part of our Health Coaching program – at no expense to him – so he could work on reducing his weight and blood pressure if he wanted to.
Our decisionAfter 8 months on the Health Coaching program, Suresh successfully reduced his weight from 94kg to 87kg and his blood pressure to a normal level. As a result of these improvements, James was able to remove the premium loadings from Suresh’s Life Cover, upon request.
Declined
After Debbie^, a 41 year old from NSW, applied for Life Cover, TPD Cover, Trauma Cover and Income Secure Cover with OnePath. On her application Debbie reported a number of existing medical conditions, including a long history of back pain, left and right knee pain and the removal of multiple skin lesions. She also reported experiencing a pins and needles sensation in her right hand and forearm for the previous 12 months, but had yet to receive a diagnosis.
The challengeAfter reviewing these additional risk factors, Debbie’s underwriter, Dean made the decision to decline her application for Income Secure Cover or TPD Cover - noting that Debbie’s combination of chronic back and knee conditions and the ongoing symptoms of pins and needles in her right hand and forearm made her a high risk of disability.
Our decisionHowever, because most of Debbie’s previous medical conditions were not life-threatening, Dean was able to offer her the Life Cover she applied for on standard rates. He also offered Trauma Cover with exclusions for skin cancer and conditions relating to her right hand and arm, ensuring Debbie could still get covered for a wide range of medical conditions.

^ Whilst the names have been changed to protect privacy, this case study is based on the actual circumstances of the applicant. This is for illustrative purposes only.