Receiving the information from your doctor is an emotional moment for your family and you But your critical illness coverage could be a strong support you can count on. It is especially important to know that you are able to file an application and get a reimbursement to cover the costs you require for the treatment.
Based on the claims reports issued by major insurers, the amount of claims that have been paid can range from 91 percent to 98 percent. A major factor to having an effective critical illness claim is submitting the claim correctly.
Here are a few simple rules and guidelines you should to keep in mind when making a claim
Give full disclosure. While it’s not too late to do this, it’s crucial to remember that you have to disclose your current health situation when you submit the application. If you don’t, it could result in having your critical illness claim rejected.
What details do I have to include when making an illness claim?
These are documents that you must provide to submit:
Completed claims form.
Medical report from your doctor. Most doctors are working within one of the “approved” country and be an expert in the disease being treated.
Diagnostic and laboratory reports.
Personal information and contact information.
Get documentation. It is recommended that you keep all medical documents. You’ll need to provide them when you file claims.
Inform your insurance provider immediately. If you’re diagnosed with a health issue which is covered under your policy, it is important to notify your insurance company about the condition immediately. This way, you’ll be able to start the process and get the claim process can begin. This ensures that you have your claim sooner and you are aware of the required documents to file your claim.
Prepare to file appeal if your claim is rejected. If your claim is denied, you may appeal. If your claim is denied on the very first attempt is not an end for you. You can collaborate with the adjuster of your insurance claim to determine what additional details are needed to support your claim.
If you need help appealing critical illness claim get in touch with Resolute Claims.
The most frequent reason for claims being denied is because they do not meet the policies definitions:
Heart attack. Certain heart ailments can be misinterpreted as a heart attack even though it’s not.
Stroke. Ischaemic attacks that are transient can be similar to the signs of stroke, but the recovery usually occurs after 24hrs. They are not covered under the policy.
Coronary angioplasty. The claims can be rejected for coronary angioplasty when there is no narrowing of less than 70 percent in more than two arteries.
Bladder cancer of the bladder. If it is detected early, it can be treated and isn’t invasive.
Consider that you’re protected. It is crucial to understand exactly what coverage your policy provides. There are different definitions of an illness covered therefore you must determine under what circumstances the illness will be covered. Keep in mind that the insurer will only pay if your claim is within the guidelines of policy. If not the claim, it could be rejected for not meeting the requirements.
For instance, there are cancers that aren’t covered. For instance, some cancers that aren’t considered important and that can be treated may not be covered under the policy on critical illness. There could also be other conditions that apply to your age, the country from which you were diagnosed and more.
The application form should be filled out in case you are not sure about the information. If there’s any medical information on the claim form that you are not sure about, speak to your physician first before you write everything down. Be sure to not leave any gaps in the form – the insurance provider may not call your doctor to verify any gaps on your application.
Failure to pay your insurance premiums. This could be tardy however, your inability to make your payments within the grace period can indicate that your policy has expired. Additionally, you must keep paying your premiums until your claim is handled.
False claims are not acceptable. In the first instance insurance companies, they will verify the legitimacy claims. If they discover you’ve made an untrue claim the company will reject your claim. They may also “blacklist” your name and it could affect further applications with other insurers. There is also the possibility of being charged because of your fraudulent claim.
These are top five reasons to why the CI claim is not valid:
1. Claimant for an undiscovered condition.
There are CI claimants who make claims even though their medical condition isn’t protected by their insurance. They might be thinking, “Well, it doesn’t harm trying.” This could be caused by confusion or a ignorance of what the policy will cover.
A patient who submits an CI claim because of a benign tumor will receive a denial of claim since it isn’t considered to be an illness that is critical and typically not covered from the coverage.
2. The claimant is claiming a condition that does not fit the definition of the critical condition.
A large part of denials relate to claims that do not fit the definition of policy. They fall into the following categories:
The critical illness isn’t sufficient severe.
There are insureds who make a claim for the critical illness covered by the policy, but their condition isn’t sufficient to satisfy the definitions of the policy for the critical illness covered by the policy. For instance, a customer who has filed a claim claiming the condition of deafness (which is covered by the policy) is not able to file a claim if the deafness is with only one ear. It is the ABI standard definition of deafness states that in order in order to be eligible for deafness to be considered a claim, it must be permanent and irreparable deafness in both ears.
The condition is caused by an unidentified source.
Examples of the most common exclusions areself-inflicted accidents and failure to comply with reasonable advice from a doctor or disease that results from alcohol or drug abuse. If the person insured is seriously ill due to having attempted suicide , and took many sleeping pills, and then falls in a coma, the Insurance Company will deny the claim.
A brief description of the term “Total Permanent Disability..
The definitions of TPD could differ between policies. It is helpful to verify the definition you have in your policy prior to submitting the TPD claim under your critical illness insurance. In most cases, the person covered is the person to decide who will be covered by his TPD policy covers. TPD could be covered by:
“Own occupation” in the event that your illness prevents the covered from performing his own job;
“Suited job” in the event that your medical condition makes it impossible for the covered from performing a suitable job based on his education and work experience
“Any job” If the disability disables the person protected from performing the necessary tasks of the job
“Specified job tasks” is when the person insures (of the same age, typically 60 or more) is unable to complete three of six work-related tasks or cannot take care of themselves.
3. Not disclosing pertinent information prior to the date of the application.
In the event of a medical issue, not disclosing important information could cause an Insurance Company to deny the claim. Critical illness policies are determined by the information that the person who is to be insured has provided during the time of application. Certain medical conditions could cause the insurer to grant the claim, but with higher rates or even refuse to cover the claim at all.
But, what is non-disclosure? It could be anything from the insured innocently leaving out certain details, that the application for insurance was not specifically asking for or request, to an intentional omission in order to reduce costs. Recently, the ABI has narrowed its definition to “non-disclosure” to include information that the insured person in the proposal intentionally kept from the person insured. This means that if the information that was a mistake made by the insured is innocent The claim will be paid according to the ABI Code of Practice.
4. Lacking the required medical documentation.
Insurance companies will handle claims primarily based on the documentation provided, however they might also decide to conduct independent tests or a doctor appointed by them to examine the cause of the serious condition. If the person insured fails to supply the required documents (i.e. they did not submit a doctor’s report on his diagnosis or the reports he provided were provided by a doctor who that is not a consultant which is required by certain critical illnesses definitions) More often than not, the claim will be rejected.
5. The filing of a fraudulent claim.
Insurance companies will take the time to examine the claim. The findings of fraud could not only result in the denial of the claim but could also result in a cost for fraud.
18 A Livingstone Terrace, Dunlop, Kilmarnock KA3 4AB
0333 050 8792