Insurance Companies are Frauds !

When nothing is wrong, they happily collects your premiums. But the second you make a claim against them, they come up with myriads of excuses and reasons to avoid payment. My case for example. When I purchased my insurance coverage for 30 Critical Ilness years ago, I was informed by my Insurance agent that on being hit by Stroke, one of the 30 Critical Ilnesses covered, nothing was mentioned at all that I must be physically incapacitated by it, you will be able to claim some some form of benefits. So I put in my claim recently and the reply came back was I was not physically incapacitated by the attack thus I was not entitled to claim anything at all. But that was not what I was told by my agent when she pursuaded me to buy. The policy was sold to me on the pretext that once it was proven to be a stroke, I will be able to make a claim. So, any expert on claims can give me any reasonable advice? Appreciate any feedbacks.

titu

PS: Not just one Company but two different Companies. Thats why I branded them as frauds.

@TS: Jason any comments? Can PM me any advice and don't worry, I won't quote you ha ha.Tks buddy.

If the term and condition stated what they said, you're on the losing side bro.

It should be stated in the fine print?

I can't find my policy ha ha. Anyway, have you heard of anybody who really go and read the whole policy they just purchased? I never do Dave. Anyway, they have sales people who misrepresent their products. Maybe I can sue the agent for misrepresentation.

Sorry mate. It's all in the fine print. Actually, insurance companies themselves are not frauds but the agents who sell you the policies may be. They often paint you a wonderful picture of what the insurance can do but don't tell you what you need to do (or have done) to enjoy the benefits.

In such situations, I would have a frank chat with the agent and give him a piece of my mind. I'd tell him that he had misrepresented the policy to me, and I'd argue that he should have advised me (as the expert in the policy) of my benefits and terms associated therewith.

Sadly, he may just hide behind the "you must read the T&Cs" argument. The fineprint is where everything lies. People are too busy and not concerned enough to read the T&Cs until something bad happens. At that time, it's too late to do anything especially if you've had the policy for some time and said nothing about it.

That said, I'm not an insurance law expert so my thoughts are based on my general understanding of what I've seen/heard.

Sorry, bro. Would love to give you better news but I don't think I can in this case.

MSIG refused to pay me $500 for my hole in one, said the receipt must be issued by an F&B outlet within Safra, or else no payment. Worst, I sent in the claim 6 days after the hole in one, the policy said I had to submit within 14 days. They waited till the 13th day to inform me the rule about spending the $500 within Safra!

Tituman wrote:

I can't find my policy ha ha. Anyway, have you heard of anybody who really go and read the whole policy they just purchased? I never do Dave. Anyway, they have sales people who misrepresent their products. Maybe I can sue the agent for misrepresentation.

Bro, it's the same in almost any industry. It's all in the fineprint. This is why scumbag lawyers get rich because they can argue both sides of the coin. You can definitely appeal and demand that your claim be paid out. But in most situations, it's not easy to do. Insurance companies love premiums and hate pay-outs. Doh!

From July 1, 2003, the definitions of 37 illnesses covered under the critical illness (CI) benefit will be the same across all 12 life and 9 general insurers providing CI benefits in Singapore. The Life Insurance Association of Singapore (LIA) and General Insurance Association of Singapore (GIA) standardised the definitions in the interests of both consumers and insurers, and all member companies providing the CI benefit have agreed to adopt the new definitions. The new definitions will apply only to individual policies issued, or group policies issued or renewed, on or after July 1, 2003


The CI benefit provides for the payment of a lump sum if a policyholder is diagnosed with an illness included in the list of covered illnesses in his or her policy. It is commonly sold as a stand-alone policy, or attached as a supplementary benefit to a basic policy. New policies will define critical illness events and, where possible, clearly specify the cause(s) of the event and the exclusions in order to ensure consistency in claims management.


This is the part I am most interested in.

"The CI benefit provides for the payment of a lump sum if a policyholder is "diagnosed" with an illness included in the list of covered illnesses in his or her policy"
"

Titu,

you may have bought your policy many years ago..

normally for critical illnesses policies, and when it comes to stroke, there are various stages..

and for events like cancer, it must be stage 2 and below.

Strokes, where i understand, must cause some form of physical inhabitations in order to be claimable.

i recently did a claim for Stage 2 breast cancer for a client/friend of mine and the claim went smoothly..

perhaps if u need help, PM me.

cheers

Technospaz wrote:

Sorry mate. It's all in the fine print. Actually, insurance companies themselves are not frauds but the agents who sell you the policies may be. They often paint you a wonderful picture of what the insurance can do but don't tell you what you need to do (or have done) to enjoy the benefits.

In such situations, I would have a frank chat with the agent and give him a piece of my mind. I'd tell him that he had misrepresented the policy to me, and I'd argue that he should have advised me (as the expert in the policy) of my benefits and terms associated therewith.

Sadly, he may just hide behind the "you must read the T&Cs" argument. The fineprint is where everything lies. People are too busy and not concerned enough to read the T&Cs until something bad happens. At that time, it's too late to do anything especially if you've had the policy for some time and said nothing about it.

That said, I'm not an insurance law expert so my thoughts are based on my general understanding of what I've seen/heard.

Sorry, bro. Would love to give you better news but I don't think I can in this case.

Jason, not to worry and tks for the frank expert opinion. I guessed I knew that part too well myself but just see if there is somebody who is able to find any loop holes, just in case. CHeers.

But it's only for individual policies issued after 1/7/03. Isn't yours before this?

Anyway, I'd be more keen on: "New policies will define critical illness events and, where possible, clearly specify the cause(s) of the event and the exclusions in order to ensure consistency in claims management."

Technospaz wrote:

Tituman wrote:

I can't find my policy ha ha. Anyway, have you heard of anybody who really go and read the whole policy they just purchased? I never do Dave. Anyway, they have sales people who misrepresent their products. Maybe I can sue the agent for misrepresentation.

Bro, it's the same in almost any industry. It's all in the fineprint. This is why scumbag lawyers get rich because they can argue both sides of the coin. You can definitely appeal and demand that your claim be paid out. But in most situations, it's not easy to do. Insurance companies love premiums and hate pay-outs. Doh!

I have just read this part from the Insurance INdustries of Singapore and I thought their definition was quite direct. This part " The CI benefit provides for the payment of a lump sum if a policyholder is *diagnosed* with an illness included in the list of covered illnesses in his or her policy. It is commonly sold as a stand-alone policy, or attached as a supplementary benefit to a basic policy. New policies will define critical illness events and, where possible, clearly specify the cause(s) of the event and the exclusions in order to ensure consistency in claims management"

Technospaz wrote:

But it's only for individual policies issued after 1/7/03. Isn't yours before this?

Anyway, I'd be more keen on: "New policies will define critical illness events and, where possible, clearly specify the cause(s) of the event and the exclusions in order to ensure consistency in claims management."

Exclusions refer to pre-exisiting conditions wheb purchasing a policy, or for example.. AIDS thru drug abuse..

normally if a person has high blood pressure, and he/she buys a policy that covers critical illnesses,

there will be an exclusion on HBP and its complications and he/she must sign a conditional acceptance letter to agree to the terms and conditons if he/she insist on getting the plan

Of cos its the agent's duty to explain to the client. if the agent didnt do it properly, such cases will be referred to compliance department and investigation will ensues

andrew-golf wrote:

Titu,

you may have bought your policy many years ago..

normally for critical illnesses policies, and when it comes to stroke, there are various stages..

and for events like cancer, it must be stage 2 and below.

Strokes, where i understand, must cause some form of physical inhabitations in order to be claimable.

i recently did a claim for Stage 2 breast cancer for a client/friend of mine and the claim went smoothly..

perhaps if u need help, PM me.

cheers

Hi Andrew, thats the point of contention from them that I must have some form of physical incapacitations before I can claimed. The trouble was that the agent sold it to me on the point that once it was diagnosed as one of the CI, I would be able to claim. Just misrepresentation. Now also very difficult because she was a friend who goes into insurance biz and starts selling to all her friends. I think a lot of us bought insurance policies from friends due to the relationship. Very difficult to go after her now....sigh

Tks Andrew, I know I can't do anything unless I can get my doctor to certify that there was permanent damaged to me.

Technospaz wrote:

This is why scumbag lawyers get rich because they can argue both sides of the coin.

@TS: ouch, is that why you left practice?

Tituman wrote:

andrew-golf wrote:

Titu,

you may have bought your policy many years ago..

normally for critical illnesses policies, and when it comes to stroke, there are various stages..

and for events like cancer, it must be stage 2 and below.

Strokes, where i understand, must cause some form of physical inhabitations in order to be claimable.

i recently did a claim for Stage 2 breast cancer for a client/friend of mine and the claim went smoothly..

perhaps if u need help, PM me.

cheers

Hi Andrew, thats the point of contention from them that I must have some form of physical incapacitations before I can claimed. The trouble was that the agent sold it to me on the point that once it was diagnosed as one of the CI, I would be able to claim. Just misrepresentation. Now also very difficult because she was a friend who goes into insurance biz and starts selling to all her friends. I think a lot of us bought insurance policies from friends due to the relationship. Very difficult to go after her now....sigh

bro, she is on your side.. and i think she wont feel good about not being able to help you

perhaps you can personally email to the insurance companies and state your case. that will be more effective.. be a firm and knowledgable customer...

i normally help my clients this way

but seriously, Tituman, from what i know, if the stroke does not have any physical manifestation, there may not be a claim.

you could always make use of the court of public opinion and whack the insurance companies.....

mox wrote:

but seriously, Tituman, from what i know, if the stroke does not have any physical manifestation, there may not be a claim.

you could always make use of the court of public opinion and whack the insurance companies.....

Well I still have not regain 100% strength on both my left hand and leg. And also I have a permanent scar in the right side of my brain which will remain there for the rest of my life. Maybe now I go to play golf, all my shots go left and right, I can claimed that that is a permanent physical manifestation caused by the attack as my drive usually go straight though not far ....wahahhaha ...LOL Will that work???????

titu

mox wrote:

but seriously, Tituman, from what i know, if the stroke does not have any physical manifestation, there may not be a claim.

you could always make use of the court of public opinion and whack the insurance companies.....

doing that not only wont help in the matter... it will only make it more complicated..

from what i know.. insurance companies value clients and being a firm and knowledgeble customer is always the best course of action.

going to court, if fail, will also be a slap on the face of the client...

be firm and speak to them personally and work it out.

mox wrote:

Technospaz wrote:

This is why scumbag lawyers get rich because they can argue both sides of the coin.

@TS: ouch, is that why you left practice?

No, I left practice because I wanted better quality of life, i.e. more time for family, friends and golf.

Boy did I get screwed.

Tks guys for giving me an insight. I know I got no hope la but just to have a rant and hear what my buddies can come up with any funny suggestions.

andrew-golf wrote:

mox wrote:

but seriously, Tituman, from what i know, if the stroke does not have any physical manifestation, there may not be a claim.

you could always make use of the court of public opinion and whack the insurance companies.....

doing that not only wont help in the matter... it will only make it more complicated..

from what i know.. insurance companies value clients and being a firm and knowledgeble customer is always the best course of action.

going to court, if fail, will also be a slap on the face of the client...

be firm and speak to them personally and work it out.

Hi andrew-golf, by 'court of public opinion' , i wasn't referring to the actual courts. but yeah, i agree that your recommendation would be the most mature and sensible way to do it.

One good thing come out of this incident though. My wife told me not to get stressed out on anything and tell me not to go screaming at my kids anymore. I must relax and go out and play more golf from mid DEc onwards....... ahhahhahha.

@Andrew and Jason, going to chase you guys out for a game comes mid Dec. so please don't hide okie? Though must pan chan as you will be playing with a much slower guy and may go siao once in a while as he got a scar in his brain... And if I do throw my clubs while at the course, please act as my witness as I don't do club throwing at all no matter what. So if that happens must be the damaged in my brain due to the scar...ahhahahah ..." physical manifestation"????

titu

Bro, I believe your experience (and scar) will make you a better golfer. Look on the bright side of things... you've got a great family, you can still play golf, you're well and you've got friends who will still buy you beer (or perhaps, a nice lime juice instead)

Technospaz wrote:

Bro, I believe your experience (and scar) will make you a better golfer. Look on the bright side of things... you've got a great family, you can still play golf, you're well and you've got friends who will still buy you beer (or perhaps, a nice lime juice instead)

Will stay off beer for now. Lime juice sound nice hahah...Jason see you soon for our first game...