While we would like to believe insurers are reasonable and professional people, the hard truth is some are not. One very recent encounters that I have is with GE regarding their as-charged shield plan policy wordings. Their as-charged shield plan policy wording does not include "radio surgery/novalis radio surgery but their standard B1 shield plan included the wordings as well. The base medishield life has that coverage as well and so are the other 5 shield plan providers.
When I enquired GE, the claims department simply brush off and say whatever is stated in the policy wording means can claim. When I enquired deeper, the claims officer say radio surgery can be claimed under radio treatment. When I enquired further, the claims officer avoided commenting on their policy wordings and suggested claims will be evaluated on a case by case basis.
Their customer service isn't any better, be it the cso or their manager, flipping their words faster than flipping prata. One moment the manager say "Just because the wordings are not there doesn't means the policy wording is incomplete. ", another moment he said "Just because the coverage is not there doesn't mean it cannot be claim", another moment they said they acknowledged the discrepancies and they will evaluate during the next iteration of the policy wording.
So even before claiming, some insurers (and probably their agents as well) are not even fully aware what they are selling.
Note: I am not GE shield plan policy holder, nor was I trying to claim anything so don't have to suggest getting a lawyer or contacting LIA or whatever. Bottomline is GE is not open to reasoning and accepting they made a mistake and they have to correct it.
Multipay policies is a good idea, but will be even better if the T&Cs are simpler.
E.g.
1. Insured can claim 100% of Basic Sum Assured for ECI.
2. Insured cam claim another 100% of the Basic Sum Assured under CI for the same condition under (1), or claim two times 100% of the Basic Sum Assured under CI if no claims have been admitted under ECI.