Currently, critical illness sufferers are not only from the elderly, but also teenagers to adults who are still productive. Call it heart disease, kidney, lung, and stroke.
Such critical illness costs a lot, especially the kidneys, heart, and lungs. Fortunately, there is insurance to ease the burden on the sufferer.
There are a number of procedures and requirements that must be completed in order for a critical illness claim to be accepted. Arbitrary?
1. Policy Is Still Inforce
The company will only pay the cost of coverage to customers whose policy status is inforce or still active. Active status is obtained if the insured routinely pays insurance premiums according to the amount specified at the beginning.
Before filing a claim, make sure that the policy status is inforce. Thus, the application can be accepted by the hospital. On the other hand, you will get quick treatment to speed up the healing process.
2. Prepare Claim Documents
The name of the claim, must be accompanied by several supporting documents including:
- Original policy
- Original form of claim submission
- Doctor's certificate tailored to the disease suffered by the insured
- Photocopy of the results of the medical examination by the insured
- Attach minutes obtained directly from the police if the cause of critical illness is due to an accident
- Attach a photocopy of the identity of the insured person
- Miscellaneous documents to speed up the claim process
3. Claim at the Right Time
Next is to pay attention to the term of filing a claim according to the category of each disease. For minor illnesses, claims can be submitted 30 days or 1 month after the policy is active. As for critical illnesses, claims can only be made after 90 days or in the 4th month after the policy is declared inforce.
If the claim time is less than the specified time limit, then the insurance company reserves the right to refuse the claim application.
4. Claims Using Indonesian
Considering that insurance claims are made in Indonesia, the documents completed by the insured must be written in the Indonesian. Surely using good and correct grammar.
The same is true if the insured is undergoing medical treatment abroad. The insured must translate the Indonesian into the language spoken in the country in question.
A reliable translator service is needed, so the translation is easy to understand. As a result, claims can be processed immediately by the company.
5. Complete Additional Information
The documents you complete can in fact be rejected by the insurance company. It could be because the writing in the document is not clear, the document is damaged, and so on. If the reason is due to the absence of additional attachments, then you can attach the additional documents separately.
In essence, do not immediately be discouraged if the claim application is rejected. It's a good idea to first find out where the error or shortcomings are, and then complete them as requested.
Complete the additional documents according to the specified time limit. If it passes that limit, the claim application is likely to be rejected.
6. Examination by a Designated Doctor
The insurer has the right to reject the claim application submitted by the insured if it finds a number of irregularities in the attached documents. For example, irregularities about the disease suffered by the insured.
Don't be surprised if the insurer asks you to re-examine the previous diagnosis of the disease. The insurer will usually appoint a trusted doctor to avoid falsifying disease information.
The results of the re-examination are binding, that is, binding on the insured, the insurer, and the doctor who conducted the examination.
7. Waiting for the Claim to be Disbursed
The filing of a claim for critical illness has a condition, namely the existence of a waiting period. This period is used by the insurer to detect the correctness of the information presented in the claim application letter. If falsification of information is found, the application is automatically rejected.
If accepted, then the waiting period for disbursement is between 7-14 working days, depending on the policies of each company.
If the waiting time for disbursement exceeds the specified time limit, you can contact the insurance company or agent. You have the right to do so because this claim is the right of each insured person.
8. Cancellation of Claim
Claims for critical illnesses can be made if the insured provides honest information about the health condition, as well as other information needed.
If the insurance company finds any forgery, fraud, or fabrication on behalf of the insured, the insurer has the right to cancel the claim.
If the sum insured has already been given by the insurer, and suddenly there is a case of fraud, then the insured is obliged to return the money. Of course, according to the amount paid by the insurer.
Truthful Information Accelerates Claims
Honesty is important to uphold, including when filing an insurance claim to avoid the possibility of rejection of a claim application that can automatically be self-defeating. With honest information, the claim process can be accelerated which makes you not feel disadvantaged due to too long waiting times.
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