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Once the authorization has been received, the junior claims handler sends (by post) a request for medical reports to the health provider together with the

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Once the authorization has been received, the junior claims handler sends (by post) a request for medical reports to the health provider together with the insurer's letter of authorization. Hospitals reply to InsureIT either by post or in some cases via e-mail. On average, it takes 14 working days for InsureIT to obtain the medical reports from the health provider (including 4 working days required for the back-and-forth postal mail). This average however hides a lot of variance. Some health providers are very cooperative and respond within a couple of working days of receiving the request. Others however can take up to 30 working days to respond. As a result, the average time between a claim being lodged and a decision being made is 3 working days in the case of short-term disability claims, and 22 working days for long-term disability claims. Naturally, so long waiting times cause anxiety to customers. In the case of long-term disability claims, a customer would on average call or send an e-mail enquiry twice while the disability claim is being processed. These enquiries are answered by the junior claims handler and it takes him/her about 10 minutes per enquiry. In about a third of cases, junior claims handlers end up contacting the health provider to enquire about the estimated date to obtain a medical report. Each of these enquiries to health providers takes 10 minutes to a junior claims handler. The total benefit paid by the insurance company for a short-term disability is EUR 5K (typically spread across 2 or 3 months). For long-term disability, this amount is 20K, but some claims can cost up to 40K to the insurance company. In case of long-term disability, the duration of the benefit (number of months) cannot be determined in advance when the claim is lodged. In these cases, the benefit is granted for a period of 3 months and a senior claims officer reviews the case every 3 months in order to determine if the benefit should be extended. Half of the benefit renewals are done after a simple check, which takes 30 minutes to the senior claims handler. But in the other half of renewals, the senior claims handler requires a new medical report, which means that the whole process of obtaining a medical report has to be repeated (except that the letter of authorization signed by the customer during the initial assessment can be reused). It often happens that the renewal takes too long and customers stop receiving their monthly benefit temporarily during the renewal process

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