by eddielkk » Mon Apr 20, 2009 10:22 am
Hi, all nice members here, i would like to seek your advices on my uncle insurance case.
My uncle bought a health insurance on past 10 years ago, and now he passed away due to lung cancer. My family are trying to get the insurance claims for his wife and daughter, but then the insurance company has rejected our claims after 1 year of negotiation.
The reason for the insurance company rejects is they claims that my uncle is havng lung cancer before purchase the insurance 10 years ago. We are really in doubts cos during that time, my uncle bought this insurance from one of his friend, insurance agent. During that time, according to my uncle's wife, my uncle did get the appointed doctor medical report approved before purchasing.
Now after a long year of paying the premium, and finally he passed away, the insurance company did not even pay us single cents, nor refuse to pay back this 10 years funds that my uncle has paid.
We really need help on seeking a way to claims back the money. Why the insurance company can simply come out a reason to reject our claims, is there any rules sue back them?
Thanks for your time on our issues here.
My uncle bought a health insurance on past 10 years ago, and now he passed away due to lung cancer. My family are trying to get the insurance claims for his wife and daughter, but then the insurance company has rejected our claims after 1 year of negotiation.
The reason for the insurance company rejects is they claims that my uncle is havng lung cancer before purchase the insurance 10 years ago. We are really in doubts cos during that time, my uncle bought this insurance from one of his friend, insurance agent. During that time, according to my uncle's wife, my uncle did get the appointed doctor medical report approved before purchasing.
Now after a long year of paying the premium, and finally he passed away, the insurance company did not even pay us single cents, nor refuse to pay back this 10 years funds that my uncle has paid.
We really need help on seeking a way to claims back the money. Why the insurance company can simply come out a reason to reject our claims, is there any rules sue back them?
Thanks for your time on our issues here.
Posted: Thu May 07, 2009 02:33 am Post Subject:
well. since that insurance company have reviewed his uncle's health by the assigned doctor . that's means they admitted the uncle is under their requirements so the uncle insured there. if the uncle really was sick from then but the company still insured him that means they cheat his uncle.
Posted: Thu May 07, 2009 09:59 am Post Subject:
Hi Tohawk, you may read Rupert's response above. The medical underwriting doesn't include tests for cancer. If OPs uncle was diagnosed with cancer at the time of purchasing the policy but withheld the information knowingly, then it’s the uncle who has cheated the insurance company and not the opposite.
Well, my uncle did not claims any treatment with them in the past.
Eddie, if during all these years of treatment your uncle never actually had turned to his insurer for compensation then what the family members are trying to claim now? :? The health insurance would pay only for medical expenses and it wouldn't pay out any death benefit.
Posted: Thu May 07, 2009 10:41 am Post Subject:
well. since that insurance company have reviewed his uncle's health by the assigned doctor
They don't do a complete medical work up to catch each and every ailment...the OP does say,my uncle is havng lung cancer before purchase the insurance 10 years ago
Doesn't matter what the doc report said, if he knew he had cancer and did not disclose this fact of the application for insurance then this is material mis-rep, and will be denied, they should also receive all their premiums back (in the USA anyway)Posted: Thu May 07, 2009 11:00 am Post Subject:
Nothing in this thread makes any sense to me.
If I understand the facts, someone bought health insurance over 10 years ago and may or may not have had lung cancer at that time. He died a year ago and the health insurer isn't paying claims. What about all of the years before that? Were there 9 years of treatment for which they did pay claims? The facts as written don't pass the smell test.
Now if you can prove that he wasn't under medication during the time of buying the policy, the insurer is acting under bad faith.
Lots of people can have health issues and not be taking medication. This is not relevant.
But if the insured person had gone through the medical check-up prior to the policy purchase and had declared fit by the medical officer of the third party agency and if you have the docs pertaining then surely you will get the claim for it.
Incorrect, as usual, Amit. First of all, one doesn't get "declared fit by the medical officer of the third party agency". When testing is done, it is done by a third party, but they don't declare someone fit or unfit. They simply send the results to the insurance company. Secondly, the insurance company doesn't declare someone fit. They approve a policy. They are approving the policy based upon medical testing AND the information that the insured gave. If the insured doesn't disclose material information, a health insurance policy won't be paid. It is highly doubtful that the insurance company did any testing at all.
The tests in medical underwriting consist of- electrocardiogarm, HIV test, blood tests to determine sugar and abnormality in urine and the like. An individual would qualify for the health coverage if he satisfies these tests.
Rupert, I don't do a lot of health insurance, but I've never seen anyone have to do any of this for health insurance. They do it for life and disability insurance, but not health insurance. This could certainly be a state by state thing, and your state may be different. Passing those exams still wouldn't qualify someone for coverage if there is something in their medical history.
well. since that insurance company have reviewed his uncle's health by the assigned doctor . that's means they admitted the uncle is under their requirements so the uncle insured there. if the uncle really was sick from then but the company still insured him that means they cheat his uncle.
No. The insurance company isn't capable of doing a complete review if the insured fails to disclose material information. It's not just up to the insurance company to discover what is wrong with someone at time of application; it is also up to the insured to disclose all material information.
eddiellk, is this a health policy in the U.S.? If not, none of us know what we are talking about, so please ignore all of the responses. If it is, we're missing too much information because this just doesn't add up.
Posted: Thu May 07, 2009 11:16 am Post Subject:
Although it's posted here I think it's a life policy eddie is talking about.
Posted: Thu May 07, 2009 10:44 pm Post Subject:
Lori, that would make more sense except for the fact that it is posted here and he said, "My uncle bought a health insurance on past 10 years ago"
Posted: Fri May 08, 2009 10:34 am Post Subject:
I know, but I think it is...based on the other comments..(for aunt etc)..a life policy honestly is the only thing that makes sense to me...so that's the assumption i went on.. :wink:
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