Mr Lai (not his real name) submitted a claim for renal failure. He is suffering from endstage renal failure and has been on dialysis three times a week since March 98.
When processing the claim, Income found out that Mr Lai had suffered from AV malformation/ epilepsy (which is a risk factor for stroke) since 1976. This condition, however, was not disclosed when he submitted his proposal in 1991.
Strictly speaking, Mr Lai's claim would have been rejected as there was a
non-disclosure of a material fact. This usually will result in a decline of coverage for dread diseases and permanent and total disability.
Mr Lai's representative, however, appealed on his behalf, citing that he did disclose that he fainted and fell during army training in 1975, which was related to his condition. But as the accident happened more than 15 years before he signed up for assurance, he could not remember the exact details.
On review, Income decided to give benefit of doubt to Mr Lai that he had no intention to misrepresent the facts of his medical condition. Moreover, we also considered the fact that the current diagnosis of renal failure is not related to the undisclosed condition.
Even though Income could have rejected the claim by 'sticking by the book' and strictly following the terms and conditions of the policy, we chose to exercise compassion and logic.
In addition to the above, although Mr Lai's condition is currently not permanently and totally disabled as certified by his doctor, his long term prognosis was very poor. Consequently, Income made an ex-gratia payment to Mr Lai for the FULL sum assured of $50,000 plus bonuses of about $20,000.
The insurance proceeds is indeed a pleasant surprise to Mr Lai; it would help greatly to defray Mr Lai's medical and dialysis costs, which will otherwise be financially draining.
Mr Lai is very grateful to Income for giving him the support and showing that it really cares for the welfare of its policyholders.
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