Thursday, July 08, 2010

Critical Illness claim

Dear Mr Tan,

I'm a middle age man who had a heart bypass operation more than 3 months ago and had incurred quite a large medical bill. Fortunately, I have always believed in the importance of insurance and had bought numerous policies for critical illness over the past 18 years.

Is it a normal practice for insurance companies to assess claims of hospitalisation and various critical illness policies jointly, withholding all payments until they have done the necessary checks with my numerous doctors. Moreover, it's more than 3 months and I haven't had any indication from the company on how I could be compensated.

It is really frustrating because they seemed to be taking their "own sweet time" in assessing my claims. First, by sending various medical questionnaires to doctors who had attended to me during my surgery/ hospitalisation, followed by my GP and now to my other specialists. What is more frustrating is that the company continues to bill me promptly for my monthly payments, including for the critical illness policies that I'm claiming against.

Would appreciate your kind advice on whether the time frame and procedure used by the company are norms when claims are involved. Thank you in advance.

It is wrong for them to keep you in the dark for three months. They should communicate with you more actively. You can write a letter of complaint to the service quality manager and insist that they should give you a reply soon. If they do not, you can lodge a complaint with MAS for the poor quality of service and bad response.
Many policyholders have encountered difficulty and delay in submitting claims for critical illness. It is better to take only a modest amount of critical illness insurance and have personal savings, rather than pay a high premium for critical illness cover where you may face difficulty and uncertaintly in getting approval of the claim (for borderline cases).
This is explained in my book, Practical Guide on Financial Planning.


Anonymous said...

A few parts in making a CI claim.
The first part is to obtain the correct complicated forms for the correct doctor(s) to fill. This comes with a payment but is reimbursable.
Next, ensure these forms together with the hospital's medical tests & other documents are submitted to the insurer.
Wait for the insurer to access the claim.
It is never a pleasant experience to make a claim.

Anonymous said...

All insurance companies will delay when it comes to claim. Before the sale they can talk all the rubbish and promises. Their life fund is affected by claims and will be lesser by the amount of claim. It means other policyholders' bonuses will be affected too.

Anonymous said...

Insurance companies and their conmen/conwomen agents like to pretend they are so concern for you, advice you to buy many Critical Illness policies, tell you 1/3 of population will get cancer, 1/4 will get heart attack, 15% will get stroke and become vegetable etc etc.

What they never tell you is the attitude they give you when you try to claim CI, plus all the extra-tiny terms and conditions that they keep quiet and don't show you when you buy.

Do you know that there are quite a few cancers you cannot claim, until it must be already 3rd or 4th stage? i.e. already spread to other organs and almost confirm will die. Cancers like breast, cervical, prostate and skin fall under this condition.

Also, for all other cancers, do you know that it needs to be at least stage 2B or even stage 3 before the insurance companies will give you your money? By then your chances of survival is already cut down by 50%, and made even worse by worry and lack of financial as the insurance is not forthcoming.

Don't believe me? Go and ask the doctors and medical specialists who handle these cases. In fact, some specialists were so disgusted with our local insurance companies that they complained to Straits Times about 1.5 years ago. ST published a few articles about this, but it was quickly ignored and hushed-up.

Regarding heart-bypass surgery did your sincere and concerned agent tell you that you MUST satisfy the following?
1) Must be open-chest surgery. Keyhole, intra arterial, catheter, and angioplasty not counted;
2) Must have angiographic evidence of Significant coronary artery blockage;
3) Consultant cardiologist must certify that the operation is medically necessary.

Furthermore, I bet that the insurance company is digging through all your medical & hospital records to see when was the FIRST TIME you saw any doctor for any chest "pain" or "breathlessness". Becoz they want to exclude all those insurance policies you bought after that date.

Anonymous said...

Yes, agree with annon 12:33PM

easy to buy, extremely difficult to get returns.

I bought an accident policy some years ago. I asked the agent to show me claim forms and how to get them, who should I send it to and what documents are considered acceptable.
he was totally taken aback and commented that I have not met any accidents yet!

My reply was: I like to simulate a claim.. to experience the administrative hurdles and understand timeframes and process.

If I had found it troublesome, I would not have bought it.

What is the purpose of Insurance?
To get money in times of disasters at the critical momemt right?

If that critical momemt arises and I face a mountain of paper work with no one to help or inefficient help... then the product has failed the acid test.. it failed its core promise of protection at the critical momemt.

The arguement that it takes time to assess claims is of course true.
But certainly, the process deserves to be expedited because of the singular principle of:

"Protection in times critical in your life"

My view is: stop payments of premiums and take them to court for causing prolonged and undue stress.. for failure to honour the contract.
If you get a second attack.. charge them with manslaughter.

Anonymous said...

I bought an investment linked crtical illness policy 10 years ago. It is investment linked but even after 10 years it has not generate any returns. I decided to surrender the policy and made a $1,200 loss

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