The Trinity of Care: Why Health Insurance Is Only One-Third of The Story.

Date Posted:Thu, 4th Jul 2024

The Trinity of Care: Why Health Insurance Is Only One-Third of The Story.

Your Health Insurance works together with your Workmen’s Compensation Insurance and your Group Life & Personal Accident protection. You have all three, and Directors and Officer’s insurance too, right?

 

Whether you run a law practice, a food processing company, a firm of accountants or a professional consultancy, this can happen to you too. Is one of your people going by taxi to see clients in Jeddah? London? Delhi? Work-related risks apply equally for a road accident on duty, getting their hand stuck in a food mixer, or falling down a flight of stairs at the office.

In this piece, Jason Freeborn tells how;

The near-death of a crane supervisor cost a construction company upwards of USD 300,000 

Left the worker’s family with: no payout, no income and turned the family breadwinner into a 24-hour care concern.  

The article will explain how to use Employee Benefits insurance to avoid losses like these and how to look after your team and your business more effectively.  

An illustrative Case Study – Early in my Middle East career, a healthcare insurance client of mine ran construction sites in 9 different jurisdictions. They were part of a global corporate group whose General Insurance (GI) lines were placed by an international brokerage. Using that brokerage had been dictated to them from head office as part of a global agreement. I had been appointed as their independent in-country broker to sort out the costly mess of a globally-placed and disastrous health insurance policy. I was not able to work on their other insurance needs.

Sadly, there was a serious, life-threatening industrial accident in Egypt. A steel crane jib-pin fell on the very man who forgot to put on the safety locking R-clip when he set-up the crane. This is what a jib-pin looks like.

Three kilos (6.6 lbs) of steel falling from 30 metres up is very nasty. His shattered safety helmet didn’t reduce his head injuries much.

In this tragic and avoidable case, the cost of casualty evacuation through an air-ambulance to a head injury and neurological recovery specialist overseas was over USD125k, plus the medical costs which ran to a hundred thousand dollars more.  

On the personal side of life, because the negligence causing the accident was the victim’s own, and it was recorded that he had been trained to do better, there could be no claim against the employer from him or his dependents. The family were now faced with the tragedy of having their father, who had been a major breadwinner, lying in a high dependency unit, immobile and requiring 24-hour care. There was no case to pursue against the construction company that employed him.

Looking to make an insurance claim, the construction company found they were not covered at all. The medical insurance policy excluded work-related illness and injury, a risk which is normally covered by a Workmen’s Compensation Policy (WMC).  The globally-appointed international brokerage which had advised on placing the WMC policy had failed to check whereabouts it provided cover. It was geographically limited to the UAE so the construction company were exposed, with no WMC cover in 8 out of 9 countries. 

Within hours of the accident I was asked, off the record, to have a look at their WMC policy and see what I could tell them.  It took me 11 minutes of reading their policy to identify the issue. Sadly, this was after the event and too late.  

There was no group life & personal accident (GLPA) cover in place either, so the family received nothing to help with their loss. They would have received between 3 and 5 years of their father’s annual salary from most GLPA policies. 

I was able to help in recovering the uninsured losses for the construction company.  They approached their international insurance brokerage and made a claim against them for the air ambulance and medical care, which would be paid for by the Directors and Officers (D&O) policy, which we knew they had in place. These policies are for situations where a company executive or one of their team has failed in their professional duty. The matter was settled by the D&O insurers without having to go to court.

How Can Life Be Better?

Healthcare insurance is only one third of the story.

In mature markets, the Employee Benefits (EB) insurance suite is viewed as the trio of; 

Health Insurance

Workmens’ Compensation 

Group Life & Personal Accident (Including Critical Illness)

These are three policies that everyone brokering health cover, which itself is far more than doctor and hospital-bill insurance, should ask to see. They need to check for gaps and overlaps. As a client, your broker should give you confidence by demonstrating holistic care, using their insurance expertise to give you the protection you need, or perhaps the protection you didn’t even know you could have.

Every broker should have this trinity of care approach to delivering Employee Benefits. Caring for people is what a good insurance broker does.

I wish never to see one of my clients get caught out like that again. When I go to meet a client company for the first time, I always ask to review the healthcare insurance, workmen’s compensation and group life & critical illness policies together, even if I am not able to broker all of them. They work as a trinity of care. Caring for people is what a good insurance broker does. That includes checking the Directors and Officers are also covered.

Offering general insurance (GI) lines as well as health insurance is an important part of insurance brokerage services. Lifecare International is a long-established, full-service brokerage which understands the risks its clients face and makes sure they are protected if misfortune arrives. Lifecare. We care for you for life.

Jason Freeborn is a Senior Associate in Employee Benefits (not just a medical insurance broker) with a decade of Middle East insurance experience. j.freeborn@lifecareinternational.com