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Greater scrutiny needed over denied claims: Forum

Greater scrutiny needed over denied claims: Forum

Source: Straits Times
Article Date: 21 Jul 2021

The author says that there is a need for a council comprising government representatives, insurance professionals and actuaries to determine the fairness behind insurers' decisions on what affects insurability and premium amounts.

I refer to Ms Denise Ho Shi Yi's letter, "Insurance claims denied because minor conditions not disclosed" (July 17).

This is not the first time I have come across cases where insurance companies deny claims based on non-related or minor illnesses inadvertently undeclared during the time of purchase of the insurance policy.

It is totally discordant to fair play, even if the small print gives big insurance corporations, with their army of lawyers, iron-clad excuses for denying payment.

The open-ended questions in the health declaration forms people fill in when purchasing a policy give insurers ample wiggle room to deny payouts.

We need to have a council comprising government representatives, insurance professionals and actuaries to determine the fairness behind insurers' decisions on what affects insurability and premium amounts.

The council should be allowed to consider the merits of any challenged case, with the power to decide on partial compensation if payment cannot be given in full.

The task of determining whether there has been any misrepresentation should not be left solely to insurers - some of whom have only their own pecuniary interests at heart.

Medical insurance payouts should be made a requirement by law for claims made by policyholders who have paid premiums continuously over a specified number of years.

Yik Keng Yeong (Dr)


Insurance claims denied because minor conditions not disclosed: Forum

Last October, I purchased a life protection policy and upgraded my hospitalisation plan to include coverage at private hospitals.

In February, I was diagnosed with stage two breast cancer. With affirmation from my financial adviser, I pursued treatment at a private practice. I began treatment and submitted my claims for my critical illness payout as well as my upgraded hospital plan's coverage.

This hospitalisation coverage entitled me to claim 100 per cent of my pre-hospitalisation bills on top of the full sum assured from the life protection policy.

Throughout, I held on to the assurance that my policy would ease my burdens, as my income was affected by my sickness.

Five months later, the insurer rejected these claims, citing failure in disclosing my vertigo and asthma. These ailments occurred one or two years before I bought the policy, during separate one-time visits to the family clinic for dizziness and cough.

I was not formally diagnosed, and I did not think these were conditions worth disclosing as there were no specialist referrals and the clinics deemed further examinations unnecessary.

Hence, the insurer's reasoning baffled me.

How could these two incidents alter my outcome? The insurer also took five months to process my claims instead of one to three months.

I asked other insurers, who said such claims should take only up to a month to help clients in times of urgent need.

I was left stranded with a whopping $100,000 in medical bills with an additional $150,000 potentially pending.

After speaking to others, I realised there were many others who have fallen between the cracks and were denied adequate care by their insurer.

Mismanagement of information can result in painful impacts on people's lives, and my wish is that we start valuing lives for what they are.

Denise Ho Shi Yi

Source: Straits Times © Singapore Press Holdings Ltd. Permission required for reproduction.

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