Insurance Policy

SevenEleven SG

THE case of a breast-cancer patient who had her insurance claim rejected because the condition was deemed to have been pre-existing (ST, Jan 31) prompts me to share what happened to two of my patients.
The first was a relatively young, recently-married blue-collar worker who died from a serious infection. When he bought his insurance policy, he did not declare his recently-diagnosed hypertension, which was being treated with traditional Malay herbs. His widow told me that the agent had advised that it was not necessary to declare a recent condition if it was mild and no medication was needed.

The policy protecting his ability to pay for his share of the HDB flat was declared invalid, even though the insurance company accepted that his death had nothing to do with the undeclared condition. Apparently pre-existing hypertension would have made him uninsurable. Sadly, the young family lost the flat as the widow was unable to bear the full mortgage payment on her small income. I believe that the premiums paid were refunded.

The second is a grandmother who needed hospitalisation and a stent after a heart attack. Her claim was rejected on the basis of her having diabetes, a pre-existing condition that she had declared.

It is true that even well-controlled diabetes is a contributory factor to heart attacks. However, 'contributory factor' is very different from 'cause'. If having a 'contributory factor' is reason to refuse a claim, this old woman needs to be told that many other illnesses she might suffer from - stroke, heart failure, kidney problems, eyesight problems, all infections - would also not be covered, as diabetes is a known contributory factor.

What can Singaporeans do? First, when buying a policy, declare all illnesses, even if they are seemingly inconsequential or do not require treatment. Declare even past illnesses - for example, raised blood sugar in pregnancy, or recurrent episodes of urinary tract infection - even if they have resolved naturally. Do this even if the agent advises otherwise.

Second, upon hospitalisation for any reason, ask if the pre-existing illness noted in a policy might be considered contributory to the current condition. If there is any doubt, consider seeking subsidised care.

Singaporeans would benefit if the authorities were to require insurance companies to list conditions that would not be covered, arising from common diseases (like diabetes and hypertension) that increase the risk of other illnesses.

People can then better choose policies, or know when they should opt for subsidised hospital care.

Dr Lee Pheng Soon

snop_coolz SG

so in the end the insurance company earn the most lor…those fine and okay 1 will b “insured” while paying premium every month…those sick and illy will b made to refunded and decline insurances..simple..in the end the company earn lor..

SevenEleven SG

I REFER to the article, ''Pre-existing condition' strikes out cancer patient's insurance claim' (ST, Jan 31).
The insurer, Aviva, should be commended for saying what it means and meaning what it says. Its contract is clear and unambiguous: all pre-existing conditions are excluded.

If there was any default, it falls on the financial adviser representative who may not have highlighted this important limitation in the cover, and on the insured, who was given 60 days to review the contract and ensure that she was satisfied with the cover provided.

I have greater concern with insurers who, in a hypothetical case presented to them, are prepared to say that they would have paid the claim, and yet could not point to specific provisions in their policy contract that demonstrate that they would have been obliged to do so.

'Ambiguously phrased' provisions are certainly not in the consumer's favour. There is nothing to stop an insurer from relying on the ambiguity to deny a claim.

The layman often does not have the resources to challenge the insurer's interpretation of ambiguous provisions.

It is more important that a contract be clear than for the contract to be fair. At least with a clear contract you know where you stand.

It cannot be acceptable for insurers to say that their practice is more lenient than their contracts suggest. Why should we believe them?

They should just say what they mean by having clear contractual provisions that express their intent and practice and mean what they say by a straightforward application of clear provisions in the policy contract.

It is important that financial advisers know exactly what a policy contract covers and that the layman knows where he stands when he takes out a policy.

We have yet to see sufficient 'plain language' insurance policies in Singapore. Many consumer insurance contracts I read are incomprehensible to me and I am a specialist in the law of insurance.

Contract uncertainty is a great cause of insurance disputes. Before consumers can really take responsibility for their insurance covers, all consumer insurance covers must be written in plain language and must be unambiguous.

In line with other developed countries, the regulator should regulate and enforce plain-language consumer policies and not allow insurers to hide behind ambiguity.

Stanley Jeremiah
President
Singapore Insurance Institute

SevenEleven SG

I REFER to the article, ''Pre-existing condition' strikes out cancer patient's insurance claim' (ST, Jan 31). Insurer Aviva's chief executive, Mr Keith Perkins, mentioned that the policy of excluding pre-existing conditions protects against abuse and that it was insufficient to rely on customers' knowledge.
While this will weed out fraudsters who conceal their medical conditions when taking out policies, in order to pay lower premiums, it also hurts customers who are genuinely buying cover for themselves and their loved ones.

A better way to protect against potential abuse is to require the customer to undergo a health check before the commencement of the policy. This way, all pre-existing conditions would be known. Indeed, if this exclusion of pre-existing conditions is to continue, the insurance companies could be the ones to abuse the term, because the evaluation of when an illness started is rather vague.

If X has a clean bill of health at the time of policy commencement but is later diagnosed with high blood pressure, would the state of his arteries, in which fatty deposits had been building up since he was young, be considered a pre-existing condition? What about a genetic predisposition? Or a preference for unhealthy food and a dislike of exercise? If read very widely, almost all claims could be excluded because they originated from a pre-existing condition.

Insurance companies should either stop excluding pre-existing conditions and require a health check or make it clear what a pre-existing condition is. Customers deserve to know what risks they have insured against, and what risks they are still left to grapple with on their own.

Esther Yee Swee Yoong (Ms)

SevenEleven SG

Ask and acertain before buying. Go for the checkup, don't skipped them because of time consuming