Monday, September 13, 2010

Non-disclosure of existing medical condition

A consumer took a private Shield policy. His claim for medical treatment was rejected due to "non-disclosure" of medical condition. However, he did honestly declare all that he knew. There were conditions that were not explained to him by the doctor, but was not used to reject the medical claim. One condition was diabetes mellitus.

When he went for a health checkup in the polyclinic, he was not told that his diabetes had reached a serious stage that require medical treatment. In fact, he was not placed on medication. His non-disclosure of this condition was used to reject a subsequent claim for a condition that is not related to his condition. I am now helping the consumer to gather evidence that he was not concealing any information.

But it is quite stressful for him to be saddled with a hospital bill of $7,000 that was not paid. If this was not covered, he would have gone for treatment in B2 ward and pay a much lower bill. Sometimes, the existence of an expensive medical insurance policy creates more problem to the consumer.

5 comments:

Walau said...

Mr. Tan, very kind of you to help.

sureesh40 said...

Hi Mr Tan

How come the polyclinic did not inform him that his condition is so serious. If that is the case they are negligent.

Anonymous said...

It is difficult to charge a government setup for negligence especially in Singapore where we are made to worship the government as in ancient China dynastic system though we have a western democratic inheritance.

Spur said...

That's why I've been saying that all insurers in Singapore now operate on "stingy" & narrow-minded mode when it comes to medical insurance.

The SOP whenever a G&H claims officer receives a claim is to go thru the hospital medical reports to look out for any chronic ailment or condition that are likely to require a long period of time to develop. If the consumer took up the medical insurance only within the last few years, say 5 yrs, and did not declare that condition, then the SOP is for the insurer to tell the consumer that he is "guilty" of non-disclosure. This is even though the consumer may genuinely have no idea that he has that condition e.g. mild hypertension but no physical symptoms and no doctors advised him about it.

These checks are much more stringent for private Shield plans, as all insurers are now fully maximum profit-oriented.

Btw, if consumer had declared he's got diabetes (no matter how mild), the standard practice for insurers is to exclude not just all treatments for diabetes specifically, but also any conditions that may arise from diabetes too. E.g. kidney disease, kidney failure, heart disease, blindness, gangrene, amputations, urology problems etc.

For those other conditions, in order to claim, you need to get specialist (perhaps also the insurer's medical board) to certify that it is not caused by your diabetes. This is practically impossible.

This is accepted practice in Singapore for at least the past 7 years already.

Kim said...

Hi Mr Tan
I am also faced with a situation whereby the insurance coy wanted to add an SPECIAL TERM for my INCOMESHIELD took up 12 years ago. I was trying to buy a POGS insurance recently whereby i declare my hepatitis B carrier date incorrectly or vaguely based on my memory. They rejected my POGS application for the reason that i am a hepatitis B carrier. While i have appealed with reason that currently i am well and my doctor in charge had said that i am well and require no medication . I have furnish them my Ultrasound result. In my appeal email, i have also mentioned that though i had taken up the INCOMESHIELD for abt 12 years already, there has been no claim made so far. Immediately, the INCOMESHIELD dept sent me a letter, with the SPECIAL TERM and wanted me to accept the term. They explained that due to my declaration at POGS form, i did not declare my pre-existing condition. Hence, they wanted to exclude any illness or treatment relating to Hepatitis B in my INCOMESHIELD plan. I wrote an email to explain to them that my declaration over at POGS form was based on vague memory and i was so call "forced" to pen in a date as there is no mention that, if policyholder cannot remember the date, they can don't put in a date. Hence afraiding that my application will be throw back, i simply declare a date based on my vague memory. I have later also searched through my medical record and managed to find out that i first discover my hepatitis B carrier status, was after the date i took up the INCOMESHIELD. I wrote in to them to explain that if need be, i can furnih them this medical result. However, after 2 months has passed, i still have yet to hear from them. Can you please advise how i should take up this case further ? I have in my email advise them to check with my doctor in charge on my hepatitis b condition also. However, seem that they are not interested to take any action. Plse help to advise how i should proceed from here.

Thank you very much

Mdm Ong

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