Critical Illness claim

[ClassyNFabulous]

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

true. so hv to see how the medical report is phrased loh, in order to meet the criteria for claiming, which the surgeon shld be able to assist to a large extent.

 

[reddevil0728]

true. so hv to see how the medical report is phrased loh, in order to meet the criteria for claiming, which the surgeon shld be able to assist to a large extent.

insurer may send to their own doctor also.

so regardless just try lor.

 

[calbeee]

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

Not sure about that but I bought my policy in 2017. My illness is covered under my policy just that the definition of "permanent" is stated there. I seek a second opinion from another doctor and he said there might be a possibility that I might never recover even though the first doctor said my condition is not permanent. Hence why I'm asking if it's worth appealing since there are 2 conflicting opinions.

 

[ClassyNFabulous]

insurer may send to their own doctor also.

so regardless just try lor.

never heard of tis.

u mean insurer may send the report to their own dr to assess the genuineness ?

 

[a4973]

I have always wondered about the staff assessing such claims. Cannot be the insurers hire medically trained personnel in all fields to perform these assessments right?

 

[a4973]

Not sure about that but I bought my policy in 2017. My illness is covered under my policy just that the definition of "permanent" is stated there. I seek a second opinion from another doctor and he said there might be a possibility that I might never recover even though the first doctor said my condition is not permanent. Hence why I'm asking if it's worth appealing since there are 2 conflicting opinions.

" a possibility that I might never recover" is different from "Permanent" so not really conflicting opinions.

 

[reddevil0728]

Not sure about that but I bought my policy in 2017. My illness is covered under my policy just that the definition of "permanent" is stated there. I seek a second opinion from another doctor and he said there might be a possibility that I might never recover even though the first doctor said my condition is not permanent. Hence why I'm asking if it's worth appealing since there are 2 conflicting opinions.

When you say worth means you are looking at some trade off. What’s the trade off?

 

[a4973]

Don't know if the insurer can take the middle ground and do something like say "kiv the claim for x number of months / years and review again thereafter" ?

 

[reddevil0728]

I have always wondered about the staff assessing such claims. Cannot be the insurers hire medically trained personnel in all fields to perform these assessments right?

The staff might don’t he first cut, then their medical director who gives the final approval and maybe they have their own panel of specialistwho they can consult

 

[reddevil0728]

Don't know if the insurer can take the middle ground and do something like say "kiv the claim for x number of months / years and review again thereafter" ?

They are the insurers can do whatever they want since they adjudicate whether to pay out or not.

the qns is whether they want and see a need to

 

[reddevil0728]

never heard of tis.

u mean insurer may send the report to their own dr to assess the genuineness ?

Why not? They may have a panel of specialist they consult for such stuff since they can’t possibly employ such medical professionals to just do claim adjudication

 

[aeng]

Why not? They may have a panel of specialist they consult for such stuff since they can’t possibly employ such medical professionals to just do claim adjudication

I just did a whole bunch of CI claims successfully.

Here's what I gathered so far:
1. The insurers do have their own medical panel to assess the CI claims.
2. They may pay out partial claims if the claim conditions are not 100% fulfilled.
3. Yes, it costs $ to file a claim cos you need to send your insurer a certified medical report from your doctors and this is usually not free, plus you need supporting documentation/x-rays/test results etc.
4. The insurers are pretty strict with the CI claim conditions but at the same time, think about it... they are not looking to deny CI claims for the sake of saving money for the company.

 

[calbeee]

I just did a whole bunch of CI claims successfully.

Here's what I gathered so far:
1. The insurers do have their own medical panel to assess the CI claims.
2. They may pay out partial claims if the claim conditions are not 100% fulfilled.
3. Yes, it costs $ to file a claim cos you need to send your insurer a certified medical report from your doctors and this is usually not free, plus you need supporting documentation/x-rays/test results etc.
4. The insurers are pretty strict with the CI claim conditions but at the same time, think about it... they are not looking to deny CI claims for the sake of saving money for the company.

Hi, thank you for your response. This is exactly what I wanted to hear.

May I pm you directly to ask some questions, if you don't mind?

 

[a4973]

I just did a whole bunch of CI claims successfully.

Here's what I gathered so far:
1. The insurers do have their own medical panel to assess the CI claims.
2. They may pay out partial claims if the claim conditions are not 100% fulfilled.
3. Yes, it costs $ to file a claim cos you need to send your insurer a certified medical report from your doctors and this is usually not free, plus you need supporting documentation/x-rays/test results etc.
4. The insurers are pretty strict with the CI claim conditions but at the same time, think about it... they are not looking to deny CI claims for the sake of saving money for the company.

Hi, for point 2, if partial claim is paid out does the policy still remain active with a reduced balance coverage? Is the premium still the same? Thanks.

For point 4, I believe it is not a matter saving $ for the company but to avoid every claim becoming a "case by case appeal" creating a precedent.

 

[reddevil0728]

Hi, thank you for your response. This is exactly what I wanted to hear.

May I pm you directly to ask some questions, if you don't mind?

what was the trade-off for you to determine whether something is worth it?

 

[qhong61]

A friend got nose cancer.
Managed to claim in first yr.
Passed away of same cancer ten yrs later.

 

[sohguanh]

A friend got nose cancer.
Managed to claim in first yr.
Passed away of same cancer ten yrs later.

Can share once claim for CI for nose cancer the policy will lapsed correct? 10 years later die that policy pay out again to dependants?

 

[qhong61]

Can share once claim for CI for nose cancer the policy will lapsed correct? 10 years later die that policy pay out again to dependants?

No more.

 

[reddevil0728]

A friend got nose cancer.
Managed to claim in first yr.
Passed away of same cancer ten yrs later.

What matters is if meet the criteria.

doesn't matter if can claim first year then pass away 10 years later.

 

[reddevil0728]

Can share once claim for CI for nose cancer the policy will lapsed correct? 10 years later die that policy pay out again to dependants?

depends on the type of policy