Contributed by Rozitah (Snr Exec, Claim), on 21 Oct 09:35 AM
We have received an enquiry by a policyholder who is about to go for surgery - the estimated hospitalisation bill is more than $7000.
Upon checking the policy coverage, we found that her policy is issued with an exclusion and the surgery which she is due to go falls within the policy exclusion..!
It is no easy task having to break the "news" to the insured. During the earlier teleconversation, she voiced her concern about the impending high medical expenses.
When she was told of the exclusion imposed, her initial reaction was, 'Oh dear! How am I supposed to afford those medical expenses??' She requested to speak to her advisor instead, who put in an appeal on her behalf for Claims to review.
When reviewing this case, we took into consideration that the insured has been our long time policyholder. Her Family Insurance policy was bought in 1997 and she has other policies with us too. At the same time, there was only 1 claim made as at todate. On compassionate grounds, Claims has agreed to pay her claims on ex-gratia basis - up to the charges of B1 ward at restructured hospital.
The insured was so relieved and happy to hear that we are extending the ex-gratia payment to her despite the fact that her condition is being specifically excluded under the policy. She had spent several nights worrying about the high medical cost and was indeed very grateful and relieved for the ex-gratia payment which definitely will help to alleviate her financial burden.
Email this page
Print this page
