Rejection of a critical illness claim

Dear Mr. Tan,

I bought a critical illness cover for my wife two years ago. Recently, she felt some pain on her breast and saw a doctor at the polyclinic. The doctor examined her and refererred her to Tan Tock Seng for further examination. She was diagnosed with breast cancer.

At the polyclinic, she told the doctor that she did a mammogram more than ten years ago. It showed a lumpy breast but The doctor at that time said that there was no need for repeat consultation. I called the clinic where she did her mammogram but was told that they could not find her previous record. My wife has all along been in good health until this unforseen illiness was detected last year.

The insurance company denied her claim becuase she did not disclosed the breast lump in her declaration form. There is no record on this matter except for her verbal conversation with the doctor at the polyclinic. Can the insurance company deny the claim? Please advise.

REPLY

I am sorry to learn about your wife's medical condition and the rejection of the claim by the insurance company.

I suggest that you write to the insurance company formally to request for the following facts to be put down in writing:
a) the coverage of the policy
b) the policy condition regarding non-disclose and incontestibility clause
c) the facts of the case, in particular the evidence of her previous medical condition
d) the reason for the rejection

If the insurance company wish to reject the claim, they have to duty to prove non-disclosure of a previous medical condition. It seems that the verbal conversation does not constitute sufficient evidence to support the rejection. You should keep a record of these correspendence. If you meet with the claim manager, you can also ask for their position to be put down in writing.

If you feel that the insurance company has been unfair in rejection of the claim, you can lodge a complaint with the FiDREC (Financial industry Dispute Resolution Center). http://www.fidrec.com.sg/website/faq.html

You can also refer this matter to a lawyer, but at a later stage.