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HOW TO AVOID HAVING YOUR CLAIM DENIED

Dated-10 Jan 2015 


3 MOST COMMON REASONS AND HOW TO DEAL WITH THEM
Now that you have added a critical illness insurance policy to your list of preparedness items, you are comfortable that you are well covered in the event of a catastrophic event. Between all the policies that are in place, you are confident that your family should be able to cover all your medical costs adequately, that is unless your claim is denied. Unfortunately, claims seem to be denied at the most inopportune times.

Your Condition Isn’t Covered

This is one of the most common reasons given for denial. There is a lack of standardization in the industry as to which conditions are covered. While heart attacks, stroke and cancer, the “Big 3”, are typically covered by all critical care illness products, coverage can vary tremendously from one insurance company to another. It is possible for one company to pay for a diagnosis of certain other diseases, and another one may not. Sometimes the devil is in the details. For example, your policy may cover cancer, but a diagnosis of a specific type of cancer may not be covered. Heart attacks triggered by blockage may be covered, but may not be covered due to other causes.

Specific conditions and requirements have to be met as set down in the policy in order for a claim to be paid. Insurance companies do not cut anyone any slack in this respect. Become familiar with your particular policy, read every detail and ask questions to make sure you understand your coverages. Your insurance professional can help with any questions or concerns you may have regarding your policy.

Wrong or Incomplete Documents
Insurance companies are notorious for being very demanding and are very specific on documentation required in order to pay out a claim. A documented diagnosis from your specialist may not be sufficient. In some cases, verification by an insurance company-appointed physician may also be required. Failure to comply with any of these conditions will usually result in a denial. If you forget to submit all the required forms and documents, your claim will most likely be delayed or denied as well. Getting complete, accurate and required information and documentation to the right place in a timely manner will ensure timely processing and payment of your claims.
Did you forget something?
The information and documentation you provide the insurance company in a claim is used in making decisions, both in issuing or not issuing coverage, as well as paying or not paying a claim. Inaccurate or incomplete information relating to a diagnosis may trigger a delay or denial as well. Do not rely on memory to provide information – get your medical records and use them when filling out your application. The insurance company will request your medical records from your health care providers as well, so be sure your information matches. If any discrepancies surface, be sure to investigate and either get an explanation in writing or get the information corrected. Do not submit inaccurate information on your application.

Sometimes referred to as “Non-disclosure”, any omissions, either intentional or accidental, can nullify or void your policy. It is best to provide as much information as possible as opposed to leaving something out in an effort to lower your premiums. Insurance companies are very good at this type of investigation.

Plan ahead
Review your policy coverages regularly and upgrade them as necessary. Maintain accurate medical records and do not leave anything to chance. Claim your lump sum payments in a timely manner.

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