Why Claim Denied Insurance companies?

Because there are many who doubt for insurance due to fears that the claims will not be paid, then I share the following article. May be useful…

The case of insurance claims not paid is one of the cases are quite annoying. Most people think of paying the insurance premium for the things that lead to potential losses. Approximately matter what causes the insurance claims is not paid or delayed payment?

Insurance Claims Not Paid

Some time ago in Indonesia there was a case of an artist whose child suffered a traffic accident. The child was later treated in hospital. The Artist as well as a father trying to take care of the insurance claim for the cost of his hospital. The insurance company originally stated in the insurance claim is not paid, because the child has violated traffic regulations.

Try Consider the case above in two different sides. Looking from the side of Mr cases above is the case that very annoying. Already have to take care of children who enter the hospital, the father must also expend effort to take care of insurance. Whereas in the beginning, the artist insuring his motivation is to fund medical care if something happens to their children's health.

On the other hand the insurance company has reason insurance companies have entered into an agreement with the father and the child in an insurance contract. There is a clause in the contract payment exceptions, one of which is a violation of law. Well this clause is used to declare the insurance company would not pay.

Reason Insurance Company Will not Pay Claims

Here are some of the reasons insurance companies refuse to pay insurance claims.

• Insurance claims are not paid if the insurance policy in case of lapse or inactive. This occurs because of failure to pay premiums. Many things that cause the failure to pay the premium, forget example, errors person who embezzled. An example is an artist named Michael Jackson that her policy lapse because of his assistants do not pay insurance premiums.
• Genesis include exclusion or exemption in the insurance contract. A contract or an insurance clause generally written things that are outside or things including an exception. If the claim occurs because of the things included in the exclusion of insurance claims are not paid.
• Claims are still in the waiting period or waiting period. Examples of a person affected by a critical illness, generally requiring a waiting period of 1 month - 1 year (written in the clause or insurance policy). Suppose someone affected by a heart attack, and the waiting period is written in the policy is 120 days. If the disease is claimed is less than 120 days the insurance claims are not paid.
• Filing a claim past the maximum limit for submission of claims. Insurance claims are not paid if we filed late. The maximum submission is usually 30-60 days. There is a difference of several insurance companies, it's good to check your insurance policy.
• At the time of signature of the insurance clause there was a hidden disease. For example at the time of signature clause person already has heart disease with ring 1. Then, one month after the policyholder so, the person died of a heart attack. The insurance company will check, if it is proven that person has a heart attack before or at the time of the signature clause, then the money is not paid insurance claims.
• The terms of the claim is not met, examples of administrative documents: medical certificate, customer claim forms, and more.
• Insurance claims are not paid if the client committed a crime, unlawful or crime insurance. Examples of a person exposed to the hot tin thief policeman and the thief entered the hospital.
• An insurance policy is usually bound in a certain geographical boundaries. If the incident is outside the area that is written in the contract, then the insurance claims are not paid.

Conclusion

In order to avoid cases of insurance claims are not paid, then take the time to read the insurance policy. Learn what things can cause insurance claims are not paid.

10 The reason why the claim is not paid:

1. Not included in clause (contractual agreement), eg died in an accident, but it turns out the customer died of illness then death claims will not be paid
2. Included in the exceptions, eg certain types of cancer such as skin cancer, prostate, etc. (each insurance company sets different types of cancer that can not be claimed. Or die for committing the crime, was also included in the exception
3. Existing disease, if the diagnosis is known that the claims filed due to illnesses that existed before the policy applies and is not listed in the policy, then the claim is not paid.
4. An incomplete document. Required documents when the claim eg doctor's certificate, a letter from the customer's own claims. Lack of any document then the claim will not be paid.
5. Still in a waiting period. Some types of claims such as critical illness, hospital requires a waiting period (the time after the policy issue) between 30-365 days. If the disease that claimed included in the waiting period then the claim is not paid.
6. In a state policy lapse. Lapse which means the policy is not active yet because of unpaid premiums which matured then the insurance company will not pay claims submitted.
7. Claims submitted through from the specified time. Usually, insurance companies set a deadline for claims between 30-60 days, the passing of time has elapsed, the claims will not be entertained.
8. Claims submitted due to customer committing a crime. Ex: hospitalizations for mass beaten while stealing.
9. Crime insurance, ie deliberately cut off fingers herself in order to get reimbursement. Or heirs who commit crimes against the insured given the amount of money claims to be obtained.
10. Located just outside the contract area. Eg: in a written contract all the events that occurred in Indonesia, but in fact there are events outside Indonesia then the claim will be rejected.

Seeing the many reasons an insurance claim is not paid, it is important for policyholders to study the contract carefully because every life insurance company has different rules.

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