Critical illness insurance is intended to give financial security to people who have been diagnosed with a serious disease. If the policyholder is diagnosed with a critical disease that is covered by the policy, the policy will pay out a lump sum of money. However, a claim for critical illness insurance may be denied at times, placing the policyholder in a precarious financial situation.
It may be a difficult and stressful experience if your claim for critical illness insurance is denied. In this post, we will look at the reasons fir a claim rejected critical illness and what measures you may take if your claim is denied.
Claim Rejection Reasons
A claim for critical illness insurance may be denied for a variety of reasons. Some of these causes are as follows:
- Failure to disclose information: It is crucial to submit correct and comprehensive information about your medical history when applying for critical illness insurance. Your claim may be denied if you fail to disclose specific medical problems or health difficulties.
- Pre-existing conditions: Many critical illness insurance policies feature pre-existing condition exclusions. Your claim may be denied if you are diagnosed with a serious disease that is connected to a pre-existing condition.
- Waiting time: Before benefits are given out, certain critical illness insurance policies require a waiting period. If you are diagnosed with a critical disease while waiting, your claim may be denied.
- Non-disclosure of lifestyle behaviours: Certain critical illnesses, such as smoking, alcohol usage, and obesity, are linked to lifestyle habits. Your claim may be denied if you fail to reveal these behaviours when applying for critical illness insurance.
- erroneous diagnosis: If your critical illness diagnosis is erroneous or not supported by medical evidence, your claim may be denied.
What should you do if your claim is denied?
If your claim for critical illness insurance has been denied, you have many options for appealing the decision. Here are some examples of what you can do:
- Check your policy: Check your critical illness insurance coverage to be sure the reason for the rejection is correct. You can appeal the decision if you feel the rationale for the denial is erroneous.
- Collect evidence: If your claim was denied due to an inaccurate diagnosis or a lack of medical proof, you can acquire more information to back up your claim. Medical records, test findings, and statements from healthcare practitioners may be included.
- Seek legal advice: If you are unclear of your rights or believe your claim has been denied unfairly, you can seek legal counsel. A lawyer specialising in insurance law can advise you on how to appeal the judgement.
- File an appeal: Most insurance companies include an appeals mechanism via which customers can contest the decision. You have the option of filing an appeal with your insurance company and providing more proof to back up your claim.
- register a complaint: If you are unhappy with the outcome of the appeals procedure, you can register a complaint with the appropriate regulatory organisation.
Avoiding Claim Rejection
While there is no certainty that your critical illness insurance claim will be granted, there are things you may do to lessen the chances of rejection. Here are some pointers to assist you avoid claim rejection:
- Provide accurate and comprehensive information about your medical history and lifestyle choices when applying for critical illness insurance. Failure to give this information may result in the rejection of your claim.
- Carefully read your policy: Examine your critical illness insurance policy thoroughly to ensure you understand the exclusions and waiting periods. Make sure you understand what is and is not covered.
- Maintain a healthy lifestyle: Eat a balanced diet, exercise regularly, and avoid bad behaviours like smoking and excessive alcohol usage. This can assist to lower your chances of acquiring a serious illness.
- Maintain accurate records: Keep track of all medical appointments, test results, and prescriptions. If you are diagnosed with a serious illness, this can assist give proof to support your claim.
A critical illness insurance claim denial can be a challenging and stressful process. However, by understanding the reasons for rejection, taking precautions to avoid it, and knowing what to do if your claim is denied, you may financially safeguard yourself in the case of a major illness. When applying for critical illness insurance, remember to submit correct and complete information, read your policy thoroughly, and live a healthy lifestyle. If your claim is denied, study your policy, gather evidence, seek legal counsel, file an appeal, and, if necessary, file a lawsuit.