Causes of Denied Insurance Claims
Experience that
I often encounter when listening to their needs and opinions, many of whom were
asked about the claims
process and their concerns
with the existing paradigm of the problems will be there at the time of the
claim.
1. The
provisions of the policy.
Cases, the
cause is the client does not understand the benefits they get, so
each agent must explain in detail the client hello to the benefits they
receive.
The most common
example is the allocation or inpatient.
Clients assume
they will automatically allocating a hospital, but was not found in the
hospital of runner political quotas.
2. The
existence of unilateral cancellation.
The most common
example is when a customer is unable to make payments and otherwise expire and
occurs when the customer has a period of
claim.
It is therefore
necessary to explain and emphasize the agency regarding the limits of the grace
period or grace period if the client can not pay again and also bonuses.
3.The basic
information that is not valid and relevant.
Totally
rejected the request could be due to the information requested at the time of
initial enrollment is not true, the most fatal of all the information that is
essential is dishonesty to report information of hereditary disease.
Another example
is smoking or non-smoking and types of information
work, all risks associated with the rating results that may affect the extent
of the value of benefits to be received by the customer in the future.
4. Agents are
not disciplined and informative.
Agents are not
disciplined and informative in explaining - the nature of the explanation of
basic necessities such as the filing of applications for more than 90 days or
not contact the office of insurance services in
the time to get the benefits of hospitalization.
5. Su1_c1d3.
When the
insured dies by su1_c1d3, while remaining within a period kontestabel (one or
two years since the policy was issued), the insurance
company has the right to refuse to pay the sum insured.
6. You hurt.
In accidental
death insurance (accidental death), there is usually a clause that excludes damage
caused by the act of "self-mutilation".
The insurance company may refuse any fatalities are caused by
speeding on the highway, on the grounds that the act of speed is
"self-mutilation".
7. Misrepresentation.
Misrepresentation
is an honest statement issued at the time of filing of the application process
(pricing), the insurance company rejected the insured and policy issue.
Misrepresentation
may be a lie revelation about their health history, age,
occupation, hobbies of the prospective insured.
As with
su1_c1d3, misrepresentation can not be used as a reason for rejecting the
claim occurred kontestabel if and only if the face of death. For example,
if the insured has not declared a dangerous pastime at the time of application,
but apparently died later in making a hobby associated with dangerous pastime.
If all this was
knowledgeable, certainly will not have problems - difficulties in making claims
first case of rejection of applications. The key is informative and discipline.
Important
Notes:
For patients
with serious illnesses potentially be the cause of death such as heart and lung
cancer - Lung and participants have a chance of an accident or at high risk
should take the time to read the provisions - the provisions contained in the
policy.
If there is not
clear, do not hesitate to contact your sales force or agent please.
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