Rejection of medical claim - congenital condition

Dear Mr. Tan,

I have taken medical insurance for my daughter since she was a baby. There was no claim for more than 10 years.

Recently, we discovered that she was suffering from a serious medical condition. The insurance company X rejected the claim as the medical condition was congenital. We feel that this is most unfair. What is your advice?

REPLY

I suggest that you bring this this matter up to the senior management of X. You can point out that this illness was discovered more than 10 years after the policy was taken up. Due to the long lapse of time, it may not be fair for them to apply the congenital clause.

Perhaps you can ask them to get their doctor to certify that the illness is really congenital and should be excluded.

If they do not give you a satisfactory explanation, you can lodge a complaint with the Financial Dispute Resolution Center: http://www.fidrec.com.sg/website/faq.html

I wish to extend my sympathies on your predicament, first on this unexpected illness and second on the rejection of the claim. I hope that the senior management of X will take a sympathetic view. I wish you all the best.