Wednesday, July 29, 2009

Company Y not wanting to pay out my insurance claims

Dear Mr. Tan,
I was diagnosed and operated upon for my brain cancer. The cancer is classified as terminal. With the doctor's recommendations & letters, CPF paid all my savings into my bank account. Company X initially refused to allow me to claim my DPS but after I send them the CPF statement - they paid me as well.

I did a similar claim with Company Y for 3 policies. For more than a year, they have been giving excuses after excuses in not wanting to pay me by saying the requirement for us to pay a claim for Total & Permanent Disability is:-

"totally & permanently disability so that life assured cannot engage in any occupation, business or activity which pays any income"


"suffers total and irrecoverable loss of effective use of
- both eyes; or
- any 2 limbs at or above the wrist or ankle;
- or one eye and any one limb at or above the wrist or ankle"

Company Y is adamant in not wanting to pay me - I even got a letter from my last employer as to why they could not hire me back and they verbally told me they need more proof of further rejection letters. I had paid my insurance premiums monthly for the last 23 years without any default to date.

I hope you can take advise me on how best to approach Company Y.

You can lodge a complaint with the Insurance Commissioner's Office in MAS. Show them evidence of payment by CPF and Company X. MAS will ask Company Y to justify their delay.

You can also make a complaint to Fidrec, As your claim exceed $100,000, you can select one or two policies that fall within this limit to lodge your complaint.

Lesson: Insurance companies usually make it difficult for the customer to claim under its permanent disability of critical illness cover, especially for large sums. This is why I recommend against insuring for large sums under critical illness. There is no point in paying so much premium and to face difficulty in making a claim.


Anonymous said...

This is very, very bad.
Just when one needs the insurance cover most and has been paying premiums faithfully, the insurer delays the payment.
Is it really must wait till THE END (sorry if my choice of words are inapprioriate) then the insurer will pay?

Anonymous said...

If you have brought critical illness policy , they had no reason not to pay u. This already stated in the contract if u had suffer in any cancer they will pay you according to your sum assure. May be you can show case to the press and let everyone to know your situation. I am sure the insurance company will do the necessary action immediately when they get to know the news.

Adrian Khiat said...

Though I do not like to comment too much on this particular case.

It seems to me that this person is still able to write such nice letter and having so much energy to push thru his agenda.

It don't seems the person is Permanently and Total Disabled.

If they pay claims for such condition, then I'll be worried.

Anonymous said...

Note that not all forms of cancer can claim payout from the critical illness plan. The definitions of 30CIs in this type of plan are very scientific, specific and "chim".

Anonymous said...

@Adrian: apparently you're an insurance agent who won't want your company to pay out to the clients' claims. There's a comflict of interest between you and your client, and how could you make sensible comments? There just isn't no way.

Anonymous said...

I just afraid that if it is NTUC, it will be like the Lehman Brothers Minibond case, complain to MAS also no use and it will never get report in local mainstream media.

Anonymous said...

The reason why this patient can write such a good letter is because his command of English is better than yours. He is well educated such that even though he is sick, his fundamental strength in writing still surpasses yours. So why didn't you study harder during your younger days?

Anonymous said...

I had ppl telling me to buy medical insurance when you are young so you don't have to pay so much when you are hospitalised. Seems like this is not the case. If you cannot make a claim, you will lose even more $.

anonymous said...

@Mr Tan:

It appears that he is claiming for critical illness from disability cover.

It's a little veering off the trail of argument to suggest that even if he were to obtain critical illness cover, that he wouldn't be able to claim it under this circumstance, isn't it, yes?

Anonymous said...

Hi Mr. Tan

I do not think if your comments are fair on this case. From this person's description, he is obviously trying to make a TPD claim on the basis of his cancer.

This person has cancer and not total and permanently disabled. Why should the insurance company pay out a TPD claim when he only has cancer?

Would you do that if you were running NTUC Income? Pay a TPD claim on a cancer?! And furthermore, you were an actuary and you should know the big difference between a TPD and a critical illness.

So if I get a heart attack or a coma and survive, can I make TPD claims on all my policies?

Tan Kin Lian said...

To: 7:29 pm poster
I do not answer personal questrions from anonymous people.

Tan Kin Lian said...

Here is a quote from an article in New York Times contributed by Paul Krugman:

... private markets for health insurance, left to their own devices, work very badly: insurers deny as many claims as possible, and they also try to avoid covering people who are likely to need care. Horror stories are legion: the insurance company that refused to pay for urgently needed cancer surgery because of questions about the patient’s acne treatment; the healthy young woman denied coverage because she briefly saw a psychologist after breaking up with her boyfriend.

Anonymous said...

...because the cancer patient can still do letter-writing and charge a small fee for it. (Some people actually do this part-time)

James said...

I am very curious to know from Mr. Tan Kin Lian, why you failed to implement changes while you are still NTUC Income CEO, that is, to educate your agents to just market Term Insurance and to advice their clients to invest the rest with Fundsupermart or iFast. In addition, why you did not remove the Traditional products and Investment-Linked products and just have Term Insurance and Health products only if you are against them...that is, to buy Term and Invest the Rest. Thank you.

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