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A Tale of Two Claims [One Word, Two Outcomes]

Posted 8 June, 2017 by Clearly
in Essential Reading, Real Lives, Real Stories

 

It was the best of times, it was the worst of times

 

Probably the most famous opening phrase in all of English Literature, it is this dramatic backdrop that we borrow to launch two real life claims examples.

In both cases, one singular word made the difference between success and failure. And amazingly, both claims examples were submitted by the same reader, KS Leow. While the claims amounts were not staggeringly big, it is the principle of the different policies that is pretty dramatic.

Read on.

 

Case 1: Malaise in Mong Kok

 

My short trip to Hong Kong over the Labour Day weekend was supposed to be fun, or uneventful at best.

Like many people, I took advantage of the long weekend for a dose of non-stop shopping and great food. The first day was passed by without a hitch but there was a nagging throat itch which degenerated into a hacking cough 24 hours later.

Well, that wasn’t really too bad. Or so I thought at first. It was the second day into my 3-day trip, and only I was affected. My wife and 7-month old son were perfectly fine. As we pushed through our crammed itinerary, my symptoms took a turn for the worse and nausea set it, followed by giddiness shortly after.

Before I boarded the plane home on day 3, I was a shivering mess. A shivering mess that broke out in cold sweats.

I arrived back home in Singapore in the early hours and bundled myself up for a long rest – only to be greeted with a temperature of 38 C in the afternoon. That’s when I bit the bullet and saw my doctor.

 

Diagnosis: Viral Pharyngitis (inflammation of the pharynx, aka a sore throat. Caused by a viral infection)

Policy bought: Travel Insurance

Specific Benefit: Post Trip Medical Expenses (The policy pays for medical expenses incurred during the trip, and also for medical expenses up to 5 days after the trip)

Claims Outcome: Successful (a grand total of 35 bucks, but hey, money is money)

Savior: My Wife (She saw fit to buy the policy before we flew. Editor: He told me to write this part in. You’re welcome bro.)

 

Making the claim was a simple affair, and this insurer had an online claims process. These were the items I submitted:

  • Boarding Pass (Proof of travel. Don’t just use it to buy duty-free liquor!)
  • Receipts from doctor
  • Medical Certificate
  • Doctor’s Memo on diagnosis (Good to have, but not necessary in this case)

 

Email confirmation

Who knew that one email could bring such unbridled joy?

 

Case 2: Diarrhoea, Delivered

 

Another time when I was supposed to be having fun, a mini-disaster struck.

My wife and I invited guests over for a party/get-together. Everyone had a swell time and the crowd dispersed around dinner time. Having been up on our feet and entertaining for pretty much the entire day, we were in no condition to prepare dinner and were also too tired to head out.

So we ordered food from a delivery company and that’s when it all unravelled.

My wife started to have diarrhoea, for a total of 6 times throughout the night. I was making regular trips to the toilet as well but still felt pretty ok – which was going to be my own undoing later.

J (My wife) self-medicated with Po Chai pills – and boy they worked wonders. (Editor: Po Chai pills are traditional Chinese medicine, specially designed to treat stomach upsets. They are bloody effective!)

But gung-ho little me rejected such ancient medicine and paid for it with more than 10 trips to the toilet, together with an episode of vomiting and of course, fever. And yes, I eventually saw the doctor.

 

PoChaiPills-6

I now highly recommend this dude in cases of intestinal distress

 

Diagnosis: Viral Gastroenteritis (Gastroenteritis refers to the inflammation and irritation of the stomach and intestines. Viral means that it was caused by a virus)

Policy bought: Personal Accident Plan

Claims Outcome: Rejected

Specific Benefit: Food Poisoning (Reproduced in full: If the Insured Person suffers Accidental Bodily Injury from food poisoning, the Company will pay the amount appropriate to the Benefits shown in the Schedule of this Policy)

 

What gives?

The claim was rejected because of the word “Viral”. Meaning that the Gastroenteritis was caused by a virus rather than through an “accident”. If the doctor had written “Gastroenteritis” instead, then the claim would have likely gone through.

I often wonder if I could have argued that I accidentally ingested the virus. The claim amount wasn’t big, but it is the principle of it all that puzzles me. Yet another thing to keep me up at night, other than my son.

 

Ed: From here we are once again reminded of the nature of Personal Accident Plans, which reimburses the Policy Owner in accidents or accidental events. Accident or Accidental means an identifiable event which is experienced by the Insured Person in a sudden, unforeseen or unexpected manner and which solely and independently of any other cause results in Bodily Injury to the Insured Person.

 

>> Read about an intriguing case of a Personal Accident Claim, the first of its kind in Singapore <<

Editor’s Close

 

We would like to thank Mr Leow for candidly sharing his experiences.

The aim here is to highlight the conditions under which claims are awarded – or denied – to have a better understanding of how policies operate. Some plans are more inherently more lenient in their clauses while others are less so.

If you have an Insurance related experience to share, we would love to hear from you as well. Who knows, the information you share may well benefit, um, me.

You can reach out to us in the comments below, or over here.

Cheerio!

www.ClearlySurely.com aims to eradicate the knowledge gap between consumers and Life Insurance. Our Vision is that one day, every Man, Woman, and Child will be properly insured.

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