Episode 3: Spinal Injury Insurance Support


This Podcast features Martin Browning - CEO, PBF Australia and EBM's Craig Goodwin. They discuss how EBM and PBF Australia work together to support people after they have received a spinal injury.



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In this podcast, we have provided general advice only and not personal advice. In giving this advice we have not considered your personal circumstances.



Welcome to Episode Three of EBM insights. This podcast discusses current topics around insurance and risk management, along with real life claims examples. My name is Sandy Cattley, thank you for joining us. Paraplegia and quadriplegia are among the most expensive chronic injuries a person can face. Today we'll be talking about how a personal financial safety net will help if you experience a life changing injury. To take us through how a significant injury can change a person's life we are joined by Martin Browning, CEO for PBF Australia and EBMs, Craig Goodwin.

Welcome Martin and Craig.


Thanks, Sandy.


So Martin, can you tell our listeners a bit about PBF Australia?



Yep, certainly Sandy PBF Australia is a national not for profit membership-based organisation, and we're dedicated to reducing the impact and incidence of spinal cord injury. We were founded by the late Sir George Benbrook, who's a renowned spinal cord surgeon in Western Australia. And he's also responsible for bringing the Paralympics to Australia and setting up a leading spinal ward. So he’s certainly an inspirational figure and he was knighted for his services to spinal cord injury. So he was frustrated back in the early 80s, with a lack of financial support for people living with spinal cord injury. So he established PBF and the first model was pretty basic. It was a membership scheme, and people paid an annual subscription and should they be injured and be left with paraplegia or quadriplegia, they would get a member benefit payment.



I see. I see. He sounds like he did a lot for society.



Certainly. Yes.



So how has PBF Australia evolved over recent years.



So since 1984, we've grown and we now also offer employment opportunities for people living with permanent spinal cord injury. So we have now around about 45 people living with paraplegia, or quadriplegia. And most of them are employed as presenters for us. So they deliver safety education presentations, usually visiting schools, high schools, clubs, or workplaces or sporting groups, and share their personal stories and also try and emphasise the consequences of unsafe decision making. So usually, each year we deliver 700 presentations to about 50,000 Australians. So during COVID we’ve had to adapt our model a bit and we're pleased to offer digital presentations now. And we've just started to develop that model. So that's exciting for us. Also, we have a peer support. So in Western Australia, we're up at Fiona Stanley Hospital, which acts as a state Rehab Centre. So the newly injured often want non-clinical advice. So we have a team of really experienced people who live with spinal cord injury for a number of years, I think the last count they had 55 years of experience between the three of them. So they cover all aspects of living and the reality of living with a permanent injury. We also have a gifting programme, whereby people non-members can apply and we can provide a grant to help them with, you know, everyday expenses and some of the recent ones, new wheelchairs or bits because this is a really expensive injury. So, those sort of things, we've developed our chorus in our membership, and we that's our, not only our revenue brings revenue into the organisation, but it offers that financial protection. Now the payment is a $250,000 member benefit payment. And we've been working really closely with EBM to ensure that the claims process is really quick. And it's really important to us to make the payment as soon as possible after injury.



So today we'll talk about one of your members also named Craig. To set the scene. Craig is a career firefighter, and in his downtime has a passion for motor biking, kite surfing, spending time with his family and working in his garden. Now in 2018, Craig's life changed dramatically. Can you talk us through what happened?



Yes, certainly. Unfortunately, no one expects a permanent life changing injury to happen and certainly that was the case for Craig, it was just a regular day for him. As you said he was a firefighter. He was on a rostered day off. And he decided to go down to the beach, which he regularly did to indulge in his passion for kite surfing. So he’s been doing this very regularly several times a week. And he's described it as a freak accident. So very briefly whilst he was getting ready preparing to kite surf, he was getting his rigging sorted out on the beach, and a gust of wind picked him up, and basically threw him down back onto the beach. And unfortunately for him, it's pretty flat beach where he was, but there was a little sand dunr, and his head went one side and his legs went the other. So the force of the impact he immediately knew as in huge trouble. Instantly he had no feeling his legs. And yet he knew certainly something was very seriously wrong. Luckily, there was some assistance. Luckily a nurse was nearby. So she came to his aid. And he eventually was transported off to the spinal award, and it was confirmed that he had severed his spinal cord. So yeah, unfortunately, there's no cure for a severed spinal cord. And Craig was left a paraplegic. So unable to walk, and certainly some other associated health problems that, unfortunately, are a part of living with paraplegia.



How do PBF Australia support Craig and his family after this accident.



So Craig was actually a private member with PBF. His wife had taken out cover perhaps 10 years prior, having heard about us through a presentation. So fortunately, as a member, and he was eligible to make a member benefit claim. So we were able to with the assistance of EBM and Craig Goodwin, push that claim through as quickly as possible. And within I think five or six weeks of him submitting the paperwork, he received the full payment. So he was still in hospital during this period, and we were able to support him with our peer support officer. So he formed a very close bond with Richard Higgins, who runs our programme. And he was able to offer him and his family some guidance and information whilst he was in hospital. Of course, the payment is essential, quick payment, it meant that Craig didn't have to worry while he was in hospital about mortgage payments or how he was going to fund this very expensive injury. Often one of the biggest issues is people are kept in hospital longer than they have to be because there's a delay in claims. So often people have to wait for either insurance or compensation claims to come through months or years later. So this quick payment meant that Craig was able to and again with the help of his firefighting colleagues, was able to very quickly adapt his entranceway into his house and his bathroom, and also his garden to allow them to have access. So he was actually able to be discharged very quickly. After only three months now sounds a long time to you and I but that's really quickly. So, like many people who suffer a permanent spinal cord injury, there are other health complications and Cray was able to direct some of the funding to have some of these medical issues treated privately, which avoided a lengthy wait on the public health system. So again, another example of how Craig was able to use the benefit payment.



So I can just add as well that I had the privilege of meeting Craig after the claim, at a PBF event and he reiterated to me how important it was to get that funding so quickly so probably shocked him how quickly it works, but not only that is it certainly gave him a good picture of getting on with his life and being positive.  And you can see the positivity in a person when you're speaking to him. How he's, you know, not letting this get on top of him. And a lot of that has to do with being able to move on pretty quickly.



Yeah, and again, studies show but also anecdotal evidence shows that the financial pressure is removed their health outcomes are improved because people are able to focus on what's important, which is the recovery and rehabilitation. So if we can help with the assistance of EBM to remove those financial pressures, it goes a long way to assist with their rehabilitation.



So, Craig, what role did EBM play in Craig's claim?



So I guess it starts off with initially just having the right policies in place. From our perspective, we've been working with PBF, for going on six years now. And the important part is, is making sure that we understand what PBF are about, what their intent is, what this this membership policy is for. So it has to be prompt, it has to be quick. There's a lot of policies, insurance policies, which are personal accident policies that don't necessarily respond properly, because they take time, there's a lot of medical things that need to go through. So understanding that PBF is aligning with the right insurer who are making sure that insurer which is a good thing that making sure they understand exactly what PBF are about and why this needs to be paid promptly. So I guess, we had set up the right coverage in place, but also working with PBF, Martin in particular understood getting the right documentation in place, so that when a claim occurs, what's needed what's required to get that payment done properly? A lot of times, we find that doctors are quite busy. Yes, in regards to and they, if they're getting insurance companies asking them for information, they're not necessarily putting that as a priority, until we actually understood the client, they understand that it's impacting the financial wellbeing of the client. So what we've done with Martin is understanding what the insurers need. And getting that done urgently at the time. So getting the authorities done by the to get the information, if we're not getting the responses, communicating back to the doctors to say hi and getting the person to talk to the doctor and say you need to get them to sign these because the insurer can't deal with those things. Make sure that we have the respect of results like we do with what Craig did, and, and others like Craig, where we've been able to get payments done really promptly and, and get people back into that position so that we can also sit here comfortably and say, we haven't actually impacted that rehabilitation, we've made sure that we've got them in a position that's as Martin said, they don't have to worry about that financial pressure. There's always going to be some financial pressure. But we take that initial part off of them so that they can get on and sometimes that is a position of, you know, just being down to a family member not being able to work for a period of time, which we've seen him in here. Yeah, so they need to take that time off or have sometimes regional areas, we've seen people having to come and move down to take, I guess accommodation somewhere, those sorts of things, knowing that's not going to be an impact does help.



The last thing we want to do is make the claims process complicated. So we want to try and make it as simple as this is the most traumatic time of their life. So Craig has done a great job in helping us develop a really simple claims form. I act as a single point of contact. Very often, there's only one set of documents for them to complete. And once completed, myself and Craig, then work directly with the reinsurer and try and keep the bureaucracy down to as minimal as possible. And again, that's much appreciated by the family members and the claimants itself in the most recent claims. They all commented about how easy and how straightforward the process was, unfortunately, compared to a lot of their other bureaucracy that have to go through for payments or other insurance.



Not necessarily to do with the Craig claim that we're talking about, but yeah, recently one of the claimants had a financial plan acting on their behalf. And he was, I think you've relayed to me, Martin, how, shocked he was that how quickly that response was in regarding to getting that payment because he's used to that situation where it does take a lot of time, a lot of documents to get Payment added for a client. In that particular claim was made within three weeks. So, you know, yes, he was certainly surprised. And again, unfortunately, a lot of our presenters or people that are associated with PBF. They, they tell us stories, we have people that have waited decades for compensation. It's very often that if there's fault, or people are trying to, to claim against the other insurance, it's a court case, you know. So, again, as insurance brokers, you'll be much more across that than myself. But unfortunately, spinal cord injuries, it's very complex. Often it drags and it's not unusual for people to be waiting five or six years for compensation to come through. And we know that $250,000 won't, it's not enough to cover for a lifetime. It's very, you know, we're talking north of $10 million for a lifetime cost of injury for paraplegia, and probably 15 for quadriplegia. But at least this early payment can help navigate through some of those difficult times.



What kind of support does PBF Australia offer its members after a claim has been settled.



Sandy, most of our work, as I've described is to try and prevent injury. So we put a lot of effort to try and reduce the incidence of spinal cord injury, and should they occur, we help with our member benefit payments. And we can provide peer support, post injury, we can offer employment, so for some people, employment opportunities are removed or they're not, they're not able to return to their work. And some feel that by sharing their story, it helps their own rehabilitation process. So we have as I mentioned, probably around 45, maybe as many as 50. At the moment that are presenters, share their stories and try and prevent people having accidents or explain the life changing consequences should you have a permanent accident. We also work with other organisations. The spinal chord committee, who I'm actually the current chair, and we share information around other agencies and we can put our members in touch with these organisations such as rebound who were formerly known, as wheelchair sports, actually secure we've ever found to them as well. So we can put them in touch with that or with other organisations offer community peer sports, so many of our claimants do actually have a really an ongoing relationship with we're so thinking of Matt, he's one of our co presenters who has actually had an injury. He received a payment from PBF. He received peer support from PBF boss who's in rehab, he had also we were able to provide him some equipment through our gifting programme. And then five years after his accident, he came presented for us and shared his story. And he focused on the Aqua programme, so he went down and visited primary school to share his story.



Yeah, very nice. And so our programmes we work with. So with the support of Ric NWA, we participate in the high school programme, which is very, very interesting. And you know, genuinely our presenters, if they can get through to one person to make them think just once or twice about the consequences of what they're just about to do that they feel that they've made an impact. It's very difficult to measure the impact we have but anecdotally I just have to walk down the street and with particularly one of our intervention, manage assignments, still the number of people that stopped him. Yes. So hey, how are you going? They might not remember his name, but they certainly remember him. Yeah. And the story that he shared and it certainly made an impact it makes me think so.



And so how is life going for Craig now?



He was a very fit and active firefighter. He's actually been medically retired from the fire service now, but he's busy preparing for living with a spinal cord injury. So he's got a gym set up in his house is still keeping fit and active. He's back driving again with modified controls on his car. And recently, as you mentioned, he purchased a modified trike, so, no doubt he's making plans to travel far and wide around Australia. But yeah, he's very positive. And he's absolutely focused on maintaining his independence and adapting to his new life. Wonderful.



Well, thank you, Martin, and Craig for chatting to me today and we wish PBF Australia and Craig all the best for their future endeavours. And for more information on PBF Australia, please go to PBF.asn.au Thank you.



It's a wrap for this podcast of EBM Insights. Thanks to our guests and for those of you listening in. If you'd like more information on any of the topics we've discussed, please contact EBM on 1300 755 112 or visit ebm.com.au

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