Monday, December 06, 2010

Indisputability clause in insurance policies

This article explains the indisputability clause, and how consumers can be protected under this clause against unfair rejection of claims.

Ask Mr. Tan


C H Yak said...

I had helped my sister with a claim when she got into a difficulty with the Insurer. It happened because Medishield was farmed out to private Insurer.

On the pretext of helping my sister to make a claim, the Insurer asked her to sign a document for access to all her medical records with the family doctor. Believing the Insurer was helping her with her claim, she agreed and signed.

The Insurer then use a certain record to assert that there was "non-disclosure"....technically there was a grey issue with "dates", even if she were to know it was a "pre-existing" medical condition and fail to declare.

The family doctor dared not even dare to support what the Insurer said...because the symptoms of the "pre-existing" medical condition was just like common cold. And the specialist doctor would also concur.

I asked her to file a police report and I wrote a letter for her to the Insurer informing that the case would be handled as "fraud by the Agent / Insurer" informing that procedures would be taken to the SMC, CPF Board and the relevant Ministry. A report was filed to the Police.

Soon the Insurer closed her case and paid the claim.

There were instances where Insurers captalised on consumers' lack of "technical" knowledge of "medical terms" and also "legal knowledge" to reject a claim. In such case, I think the first step is to file a police report.....Worst to come if it is a big case and their lawyers are involved.

yujuan said...

Thanks to TKL and readers' comments, we are receiving free education on insurance and other investment products on computer, without stepping out of the house,
better than asking questions diectly from insurance staff, who heehaw and give ambigious answers, just to entertain us.
Good reminders on this article.

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