Supporting your clients during a difficult time

Published  26 September 2023
   5 min read

In 2022 we paid 99.4% of all claims, helping 79,084 customers and their families at a difficult time.1 

Our claims track record remains consistently strong, and it shows we’re committed to paying claims. But we're about more than just numbers - we aim to go over and above to support your clients in times of need by providing a personal and supportive claims experience:

  • With a small team of claims specialists who handle all of our claims it means your clients only need to explain their circumstances once, making things a bit easier for them at a difficult time
  • If at any time during the term of their plan, your client or their partner and children, suffer a serious physical or mental illness, injury or bereavement, our Helping Hand support service will be there for them – even if they don’t make a claim
  • For customers who need help financially to pay for a funeral before the plan can fully pay out, we offer a funeral pledge - which is an early payment of up to £10,000
  • About 35% of our life cover claims are processed immediately and without medical assessment, normally within 24-48 hours of receiving the death certificate or other appropriate documents.  

Helping Hand is a package of support services, and each service is provided by third parties that aren’t regulated by either the Financial Conduct Authority or the Prudential Regulation Authority. These services aren’t part of our terms and conditions and don’t form part of your client's contract with us, so can be amended or withdrawn at any time. This means that your client's or their family’s access to these services could be amended or withdrawn by us in the future.

Claims we couldn’t pay out

We know that if someone needs to claim, something devastating may have happened, so when assessing a claim, we always look for a way to pay. But despite exploring every avenue to pay claims, in some instances the medical evidence we receive confirms that they aren’t valid, which means we’re unable to pay.

There are two main reasons for this: 

  • Definition – your client’s policy doesn’t cover what they are claiming for. For example, they're claiming for breast cancer but the lump is found to be benign
  • Misrepresentation – incorrect or incomplete information was provided during your client’s application process which, if correct and complete, would’ve meant we couldn't have offered them the cover applied for. For example, they tell us they've never had a stroke, but we find out they had one before they applied for cover.

In 2022 we couldn’t pay out on 0.6% of the claims received, with 53% declined for misrepresentation, and 47% for not meeting the definition.1  

1 Royal London protection business claims paid (1 January 2022 to 31 December 2022).

Paying claims which don’t appear valid

But on the flipside, sometimes we pay claims you might not expect us to – it doesn’t happen often, but it does happen.

Where it’s uncertain that a claim is valid, having a conversation with our claims team can make all the difference. We can look at what happened, consider any mitigating circumstances, and ultimately ensure we’re satisfied that whatever the decision, we’re being fair. Sometimes that means we go further than just honouring the terms and conditions of the contract.

A recent example was when we were asked to consider a claim when the customer was diagnosed with cancer after their plan had expired. On the face of it, this isn’t valid. Thankfully their adviser got in touch and during this conversation we learned that their client’s appointments with the NHS had been delayed for various reasons, including the Covid-19 pandemic. We assessed the claim and were able to conclude the definition would most likely have been met during the term of the plan had the delays not taken place, so we paid his claim because it was the right thing to do.

In another situation, we paid a claim where we couldn’t establish whether the client met the definition. Despite many attempts to gather the relevant information from their doctor, we couldn’t get the information we needed.  We were uncomfortable with the amount of time it was taking, so we worked with our medical team to see if we could use the limited information we had to pay their claim at that point, while we continued to chase the client’s doctor– we believed it was the right thing to do.

How you can help

If you find yourself or your client in a situation where the circumstances have worked against them, please speak to us. We can’t promise we’ll pay the claim, but we’ll do everything we can to ensure a fair outcome.

You can find more information on our claims experience and how we support your clients at a difficult time on our claims page.