Jemma’s Story (real example)

Jemma (name changed for privacy purposes) is a young woman, unemployed and on Centrelink unemployment benefits when she fell from a 6 story building and became a paraplegic with serious spinal and organ injuries. While in hospital, she met another client of HFI who recommended our services.

After getting to know us, Jemma felt sufficiently comfortable with us to divulge that she lives with a severe diagnosed mental illness, depression and anxiety. Jemma also admitted that it was hard for her to maintain a job because of the mental illness, though she tried.

How We Managed to Obtain $270,000 for Jemma ?

Due to Jemma’s prior medical history and our experience with people living with mental illness, we contacted her past employers and located to still current superannuation accounts with very small balances. However, two accounts also contained Total and Permanent Disability Insurances worth $270,000 combined. We analysed the insurance policy fine print, and found in the wording that her history of mental illness may be used by the insurance company to avoid paying her. We were very careful not to excite Jemma’s emotions, and carefully devised a strategy to maintain her emotional wellbeing should a potential claim be rejected. To maximise her chances of a successful claim, we explained the situation and referred her to a competent law firm within our network of highly trained lawyers. We also negotiated preferential discounted rates for her representation. After 8 months of supporting Jemma and the solicitor, the first payout of around $170,000 was approved by the insurer. Prior to her receiving the payout, we asked a trained psychologist from Allevia to accompany us to Jemma’s home to assess her home situation for potential abuse of her and her insurance payout. We found she was in a loving relationship, and no signs of abuse. We then devised a detailed strategy that makes it possible for Jemma to achieve her objectives of receiving a regular income to subsidise her DSP, continue to receive Housing NSW support and subsidy, and purchase an electric wheelchair. We wrote this in simple and plain English so she feels in control with pictures and colour coded diagrams to help her long term memory. We also engaged her family members in the process so she felt more comfortable and supported. We also recommended the first thing she should do is obtain Private Health Insurance with a high level of hospital cover.

The Social and Economic Benefit

While it is hard to estimate, research has shown it costs $260,000 to support a paraplegic in the first year, and $2.85 million during their lifetime (Walsh J. Cost of Spinal Cord Injury in Australia. Paraplegia). This figure is largely based on Centrelink benefits and hospital stay. With hospital cover, the system will save on average $500/night (up to $50,000 for 100 day stay, which is common due to co-morbidity conditions such as kidney failure) and up to $45,000 in spinal fusion surgery. With Private Hospital Cover, Jemma will have access to priority treatment and her own room when available. Not only did this help Jemma feel valued and boost her self-esteem, it also meant her wait for surgery was significantly reduced. Jemma can now afford a spinal surgery that may see her walk again, and eventually lead a normal life. She has already purchased an electric wheelchair, at a cost of $15,000 so she can do her own shopping and participate in the community, rather than going on a waiting list that is up to 2 years for a government funded wheelchair. Finally, she is looking forward to going overseas and visiting her grand-parents, which was a distant dream for her.

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