Tuesday, October 10, 2017

Unfair to reject claim due to alleged non-declaration

Published in St Times 10 Oct 2017

As president of the Financial Services Consumer Association, I have been approached on several occasions by consumers who had bought integrated Shield plans and gone for expensive treatment in private hospitals.

Prior to admission, they checked with their insurance agent and were assured that the treatments would be covered under the integrated plans.

However, their medical bills were subsequently rejected by the insurance companies.

When processing the claim, the claims officer checked the medical history of the insured and found some conditions that had not been declared when the insured applied to upgrade to the integrated plan or to reinstate the cover after it had lapsed due to oversight in premium payments.

In some cases, the insured was not aware of the past medical condition or the need to declare it in the application.

The alleged non-declaration was, nevertheless, used as the reason to reject the claim.

The practice of rejecting claims due to alleged non-declaration is unfair to consumers.

These medical bills are usually of large sums, involving several tens of thousands of dollars. If the insured person knew that the cover would be rejected, he would probably have opted for subsidised treatment, which would be covered under the basic MediShield plan.

I ask the Monetary Authority of Singapore to require insurance companies to check an applicant's medical history at the time of processing the application for upgrading or reinstatement.

If they are not satisfied with the medical status of the applicant, they should reject the application at that time.

If the insurer accepts the application, it should be barred from rejecting a claim on the grounds of non-disclosure of past medical conditions.

I hope that the authorities will act on this matter urgently, as it involves a large number of people, including many from the lower-income group, who have to pay large medical bills due to rejected claims.

Tan Kin Lian
President
Financial Services Consumer Association

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