Critical Illness claim

[calbeee]

Hi, I have a question regarding critical illness claim.

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied? And if so, would there be any chance if I appeal for at least a partial claim?

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Anyone with experience can advise on this? Much appreciated!

 

[BBCWatcher]

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied?

Probably.

And if so, would there be any chance if I appeal for at least a partial claim?

Chance? Almost anything is possible.

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Then the claim should and probably would be denied. Or at least you should assume it would. You wouldn't have a realistic financial plan if you base it on an insurance carrier that exceeds its contractual obligations to you.

 

[reddevil0728]

Hi, I have a question regarding critical illness claim.

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied? And if so, would there be any chance if I appeal for at least a partial claim?

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Anyone with experience can advise on this? Much appreciated!

Unless you don’t want to go through the trouble without knowing it is certain, why don’t just try it?

 

[soneat]

Hi, I have a question regarding critical illness claim.

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied? And if so, would there be any chance if I appeal for at least a partial claim?

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Anyone with experience can advise on this? Much appreciated!

I think you already know your claim is unlikely to be approved since it did not meet the definition.

The only thing you can do is to attempt to claim and appeal if the claim fails. Outcome of the appeal will of course depends on the insurer as well as ur justifications to support the appeal.

 

[aarontansp]

Hi, I have a question regarding critical illness claim.

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied? And if so, would there be any chance if I appeal for at least a partial claim?

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Anyone with experience can advise on this? Much appreciated!

If it doesnt fulfill 100%, it doesnt exists. Period.

 

[sohguanh]

I am with the readers who say just go ahead and file a claim. By filing a claim at least you know insurer accept or not. Unless it cost monies to file a claim? Else no harm to file a claim and see what is the outcome. By not filing a claim you yourself think it is not claimable? Afterall you pay premiums isn't it? And you make your own decision? Insurers will be very happy to have many more of you so "nice" customers.

 

[dgeralds]

Hi, I have a question regarding critical illness claim.

If I'm diagnosed with an illness that's covered under my insurance plan but does not fulfill 100% of the definition, would my claim get denied? And if so, would there be any chance if I appeal for at least a partial claim?

For example, the definition of the illness indicates the word "permanent", however, my doctor is unable to determine if my condition is permanent or not at this stage.

Anyone with experience can advise on this? Much appreciated!

Generally insurance are not friendly when comes to claim except when the person is dead. But you can always try....

 

[sohguanh]

Generally insurance are not friendly when comes to claim except when the person is dead. But you can always try....

The reason is obvious isn't it? How do insurers debate that death is not claimable? Unless there are cases ppl die more than one time? Hmmm....

 

[BBCWatcher]

How do insurers debate that death is not claimable?

Consider the case of a missing person. From what I can tell it takes at least 7 years to obtain a death certificate in Singapore for a missing person.

 

[reddevil0728]

I am with the readers who say just go ahead and file a claim. By filing a claim at least you know insurer accept or not. Unless it cost monies to file a claim? Else no harm to file a claim and see what is the outcome. By not filing a claim you yourself think it is not claimable? Afterall you pay premiums isn't it? And you make your own decision? Insurers will be very happy to have many more of you so "nice" customers.

aye aye aye.

I have yet to figure why people bother asking whether can or cannot, or whether successful or not, unless the experiences of other will impact whether

1) They bother to file a claim
2) Because it is troublesome to file a claim so only will do so if there is at least 1 success story
3) cost money to file a claim.

Not as if the members of this forum (and specifically ppl who will look at this thread and bother replying) is representative of all cases. can you imagine if nobody say got success story, that means don't bother filing to see for certain whether will get or not?

everybody circumstances different. unless one can go into deep details in this forum, no way to be certain whether the experience of 1 will apply to the other.

the time spent to post here can be better put to filling a claim.

that being said, it will be a different story seeking thoughts here on how 1 might be able to game plan the claims process. that is definitely worth asking about.

if not just file?

Don't file a claim = confirm wouldn't know whether will succeed
File a claim = will be certain whether succeed or not

 

[a4973]

What about getting 2nd, 3rd, 4th etc opinions? Maybe you might get lucky and find a doctor that is willing to certify condition as "Permanent"?

 

[BBCWatcher]

What about getting 2nd, 3rd, 4th etc opinions? Maybe you might get lucky and find a doctor that is willing to certify condition as "Permanent"?

Possible, but you’d have to pay to obtain those opinions. Moreover, just because you might find one doctor who disagrees with three others doesn’t mean the insurance company has to accept the minority viewpoint.

 

[calbeee]

Thanks everyone for your reply.

Actually I have already filed for the claim, just that I wanted to see if anyone has similar experience / success stories appealing should their claim be denied based on not fulfilling 100% of the definition in the policy.

I'm now just waiting for the claim assessment outcome and will see if it's worth appealing if anyone has similar experiences here.

 

[reddevil0728]

Thanks everyone for your reply.

Actually I have already filed for the claim, just that I wanted to see if anyone has similar experience / success stories appealing should their claim be denied based on not fulfilling 100% of the definition in the policy.

I'm now just waiting for the claim assessment outcome and will see if it's worth appealing if anyone has similar experiences here.

You need to have a basis for the appeal, something that was previously not known

 

[a4973]

I vaguely remember that there were some changes to CI definitions recently. Is your CI policy a new-ish policy with the new definitions?

 

[a4973]

You need to have a basis for the appeal, something that was previously not known

I think poster's appeal is based on Goodwill.

 

[reddevil0728]

I think poster's appeal is based on Goodwill.

Then just try lor. If nobody succeeded here doesn’t mean TS wouldn’t

 

[a4973]

Then just try lor. If nobody succeeded here doesn’t mean TS wouldn’t

If it doesn't cost extra to appeal then no harm but I believe if he needs extra documentation and input from the doctor, those are usually charged.

 

[ClassyNFabulous]

your surgeon never ask if u hv a well covered insurance? And then in his/her best ability, write a report medically well phrased to let u claim, not bullshait report, but at least to avoid doubts from insurers.

so far I came across 2 private drs dat are so helpful

 

[reddevil0728]

If it doesn't cost extra to appeal then no harm but I believe if he needs extra documentation and input from the doctor, those are usually charged.

then that's not goodwill already what.

your surgeon never ask if u hv a well covered insurance? And then in his/her best ability, write a report medically well phrased to let u claim, not bullshait report, but at least to avoid doubts from insurers.

so far I came across 2 private drs dat are so helpful

doesn't necessarily mean the insurers will have to accept.