Tan Kin Lian's Blog: Unfair application of exclusion

Monday, January 04, 2010

Unfair application of exclusion

A policyholder took a travel insurance policy. He met with an accident and lost a tooth. He required immediate treatment overseas and follow-up treatment in Singapore. He submitted a claim for the dental expenses. He was told that his travel insurance policy excluded "all dental expenses".

This is an unfair application of the exclusion. The exclusion was intended to exclude claims for treatment due to poor dental health, but should not (in my view) be applied to dental treatment arising from an accident.

5 comments:

Anonymous said...: REX comments as follows,

Did the policyholder first get a statement from the local police or authorities that the accident directly caused the loss of a tooth and required immediate dental treatment?

I think most office workers in singapore are extremely bureaucratic, the clerks who receive the claim sees a "dental claim" and just throws it out without giving a thought. A letter from the adminsitrators in the overseas country would probably be needed to show proof of the linkage between the accident and the loss of tooth.

It's all paperwork, useless paperwork. I think the insurance co would most probably pay if the above procedure were applied, it would be very ridiculous and unfair if they don't.

rex; January 04, 2010 8:58 AM
Anonymous said...: This is how insurance company stays profitable.; January 04, 2010 8:59 AM
Anonymous said...: I believe usually the policy clearly states that although dental expenses are excluded, dental expenses due to accidents are not.
Maybe it is really paperwork problem.; January 04, 2010 1:52 PM
Anonymous said...: If your insurance claim is rejected, request (demand if necessary) that they give you an official rejection letter stating the reasons.

I did this after a certain insurance company rejected my claims which I submitted in writing.

I called 1 month later to follow-up on progress. I was verbally told the claim was rejected.

I requested an official letter.

I had to follow-up again 1 month later to chase for the rejection letter. They told me they had already sent the rejection letter.

I went down to their head office to demand to see the rejection letter and to get a photocopy of said letter. So sorry, the officer handling my case is not in. And nobody is able to stand-in for the officer who was missing in action.

I asked for the name of the officer in charge of my claims. I then called customer service to complain, telling them I intend to get a copy of my rejection letter come hell or high water.

Mysteriously, I was called about 3 days later that my claims have been approved.; January 05, 2010 7:46 AM
Anonymous said...: This is exactly how I saw Mr Tan, during my time at NTUC. He had a system in place where when the Jr. claims officer rejected the claim based on policy conditions, the claimant could always appeal and a couple of senior officers will review and knowing Mr Tan's thinking, would approve the claim, based on what was the initial objective of the policy exculsion.
I learnt how to be fair and objective during Mr Tan's tenure. It was not all about money.
In motor insurance he made sure it met its objective of providing cover at reasonable premium, unlike now where the premiums are "indiscrimately" being passed on to customers! I remember many people use to lambast Mr Tan, from the workshops to the policyholders about the initiatives he implemented to curb excessive claims... now we can see that Mr Tan was right!; January 05, 2010 9:32 PM