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.

Insurance Claim
In fact, there are some general explanations that can cause problems or even reject the application at the time. Include the following:

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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