Tan Kin Lian's Blog: Rejection of Shield claim

Wednesday, June 18, 2008

Rejection of Shield claim

Dear Mr. Tan,
I am writing to you to seek your advice on how I should go about seeking redress with regards to my claim with Y.

I bought the Shield plan from Y. I was hospitalised 9 months later for angioplasty (ballooning). Y had written to state that they are not covering me because my hospital discharge summary indicates the diagnosis as : Primary - Ischaemic Heart Disease, Secondary - Hypertension and Hyperlipidemia and that I did not declare that I had high cholesterol.

I did a health screening with my GP and results showed that my cholesterol level was slightly high. My GP advised me to do more exercise and lead a healthier lifestyle. He deemed it was not necessary for me to be on medication. I carried on my life as usual without making much changes at all as I didn't take the condition seriously.

I did another health screening a few years later. My GP told me that my cholesterol level had improved slightly. It was not necessary for me to go on medication.

All this while, it has never occurred to me that I have high cholesterol because I was not on medication. As a layman, I sincerely and honestly didn't know the seriousness of having high cholesterol which may lead to heart disease.

When I was asked questions about my health during the proposal, I had declared whatever I know (ie, on medication for high blood pressure which was under control.) In Y's proposal form, there was no question asked about cholesterol. If it is an important factor in risk assessment, I think it is only fair to include this question.
CY

REPLY
I suggest that you write to Y and pose them the facts that you have presented. If they wish to reject your claim due to non-disclosure, it is their duty to prove that you have deliberately hidden a material fact.

As they did not ask about your high cholesteral, and you were not aware about its significance, you have a right to press for your claim to be approved. Let us see what is their reply to this matter.

If you feel that your claim has not been handled fairly, you can lodge a complaint with FiDREC. They will appoint an independent assessor to look into this matter. Their contact is:
http://www.fidrec.com.sg/website/faq.html

14 comments:

Crazy Aries said...: "As they did not ask about your high cholesteral, and you were not aware about its significance, you have a right to press for your claim to be approved."

I disagree with this statement, it is the policyholder that need to declared of any pre-existing illness (on medication or not is not impt). How on earth will the agent or whoever help him to apply the policy knew that the insured medical condition if not told.

CY, your GP mention that your condition is not serious enough to go for medication, however, do you think that the GP dare to write an appeal letter to declare you have no high cholesterol at all.; June 18, 2008 5:35 PM
Tan Kin Lian said...: vfocus represents the view taken by many insurance professionals in Singapore.

I do not agree with their views. They are too quick to reject a claim. They give a bad name to insurance.

Many people find that insurance cannot be trusted. This is due to the attitude of insurance professionals in being too quick to reject claims.

In other societies where the rights of consumers are more actively protected, the insurance companies cannot get away with the type of decisions that are quite common in Singapore.; June 18, 2008 8:01 PM
Vincent said...: vfocus, this is what I see from most of the insurance sales people. They appear very nicely to you, no problem, this can, that also can. Until you sign that policy, you will see the truth. I think it's better to be upfront about the claim process, etc. It is never properly mentioned, and even some has little knowledge about it. Most insurance guy just give the impression "quick sign that form". I don't say all like that, I understand that they have also quota to achieve, to behave until like that.

Back to the high cholesterol thing, when doctor mentions about high cholesterol, but nothing to worry about at this point, just lead a healthy life. Who the hell will declare that in their policy insurance form?; June 19, 2008 1:05 AM
Crazy Aries said...: Hi vincent, I disagree with you, this is unfair to the rest of the policyholder.

Bear in mind that this is a medical insurance not a life policy.

If the insured delcare that he had high cholesterol history, his application might be rejected, load premium or exclusion.

In the case that everyone assume it all right not to declare if they think their condition is not consider serious, in the future, claim experience will be high, all those who delcare truthfully will suffer increase in premium due to the black sheep.; June 19, 2008 1:11 PM
siewkhim said...: I bet my last dollar, the claim will finally be rejected. The insurer has the financial stamina and the connections. We end consumers have nothing except to demand on.

My view has been:

Stock market: Immediate fraud
Bank: Short term fraud
Insurance: Long term fraud.

I regret that I have to live in this world when these things are going to go on forever!!!!!!; June 19, 2008 2:19 PM
Raymond T said...: Where will you live then? ;); June 20, 2008 10:34 AM
siewkhim said...: Dear Ray,

It a figure of speech lah bro. Does not mean that I should live elsewhere.

Let not be distracted by this and let refocus on the issue at hand: " Are we at the mercy of the products sold by financial institutions run by qualified highly trained professions"; June 20, 2008 11:54 AM
Khiat Han Hwee Adrian said...: I think claiming from an Insurance Company is not as hard as some of you think. Such example probably forms less than 1% of all claims.

Insurance companies will pay when claim conditions are met but it cannot be a charity when the conditions are not met.

It will be unfair to those who are healthy when claims shouldn't be paid.

Adrian Khiat; June 21, 2008 1:40 AM
Falcon said...: In order for polichholders to have peace of mind why not the insurance companies allow policyholders to take a medical examination and then do all the necessary checks in order to certify them fit for claims should death occurs? Why wait until death occurs and then challenge the dead on why he or she did not declare this or that?; June 23, 2008 1:49 AM
Jeow Li Huan said...: The exact clause

Have you ever been told that you have, or been treated for a) cancer, b) growth or tumour of any kind, c) diabetes, d) epilepsy, e) hypertension, f) stroke, g) heart disease, h) kidney disorder, i) hepatitis or liver disorder, j) lung disorder, k) nervous system disorder, l) gynaecological disorder, m) hearing or speech problems or any disorders of the ear, nose or throat, n) AIDS or HIV infections, or o) any other illness, disorder, operation,physical disability, accident or serious condition notmentioned here?

High cholesterol isn't specifically stated, but might be vaguely lumped under the o) other disorder. Might try to fight the case if you had declared that you have hypertension.; June 23, 2008 2:49 PM
Falcon said...: There was a case last year about a man who died of diabetes. When his widow tried to claim, she was told that her husband did not declare that he had high blood pressure. How these insurers checked is through the national healthcare system. The poor dead man may have gone to a polyclinic for a common cold and the doctor has taken his blood pressure, sometimes without even bothering to tell the patient how high it is. To have a reading of high blood pressure years ago, not the poor wife with children in tow have to go to the courts to settle the case. Furthermore it is documented evidence against a dead man's words. Since dead men tell no tales, it is easy to see how insurance companies get away with it.
Why don't insurance companies provide an avenue for policyholders to have peace of mind by letting interested policyholders take whatever tests required of them, do whatever checks required of them while they are still alive and then proceed to issue a certificate of incontestability for a certain fee for ensuring peace of mind? Why wait until the man died and then pick a one-sided fight with its teams of lawyers? For this point alone, I think policyholders are better off terminating their policies for peace of mind rather than continuing in this one-sided unfair game.; June 23, 2008 4:07 PM
zhummmeng said...: If all avenues failed there is one last hope, get the agent. Did he or she advise or ask you to declare whatever you needed to , should or ought to and that whatever you could remember or did he or she help you to remember
or jog your memory? Did the adviser or insurance agent explain or interpret for you the questionaire?
If he or she is found negligent in this respect you can sue against the adviser under the law of tort.
The rationale is adviser must exercise due care and diligence when giving advice and is incumbent upon and onerous on him or her that the customer understands clearly and unreservedly the ordinary meaning of the questionaire. If the agent fails because of his or her lackadaisical attitude he or she is liable for the insured's inability to claim.; June 23, 2008 10:55 PM
Falcon said...: When one is grieving for a departed loved one, the last thing he or she wants to do is go to court for a fight with anyone.; June 24, 2008 8:18 PM
zhummmeng said...: The insurance agent is the primary underwriter and he or she has all the opportunity to see, ask, help, interpret,interrogate the client upside down in the interest of the client and himself. If the agent has 'any oh how' attitude and imcompetent
then henceforth it is luck and hope that nothing will happen in the future.; June 25, 2008 1:56 PM