14/03/2024
How can one claim for critical illness insurance?
This is an actual claim story of my personal client last 2023.
All personal details are hidden due to Data Privacy Act in the Philippines.
She was a very young successful business woman who was planning to get a retirement program with me.
During our conversation, I advised to add critical illness coverage. She said, "cge pwede naman, but my main purpose is just a savings program for myself."
So in the end, we just added P1,000,000 as critical illness coverage since it was not a priority because she was very young and healthy. She had never been hospitalized before, and she lives a healthy lifestyle.
The policy was issued October 1, 2022. Fast forward 4 months after, February 2, 2023, I received a private message from my client asking if she can claim for critical illness.
I asked her, what was the findings, and she said it was Cancer.
We processed the claim, and my client received the P1,000,000 critical illness claim, plus the 10,000 Daily Hospital Income even if she only paid for 4 months.
How is it possible that the claim was approved?
During inception of the policy, all important health, occupational, avocation and lifestyle details that affect health is properly declared.
No concealment of important data and everything declared must be true.
It is true that the contestability period exists and this gives the life insurance company time to do further investigation. But it is the same law regarding contestability that binds the insurance company to pay benefits to the client, if no concealment was found.
As insurance agents, we are licensed under the Insurance Commission to practice our profession as guided by the Ethics and guidelines under the Insurance Code.
Usually claims cannot be approved if material information is concealed by the client, OR THE SERVICING AGENT.
Why will an insurance agent conceal material information? Maybe to get the commission, qualify for a trip incentive, or is after a recognition title. If no declarations made in an application, issuance of the policy is fast.
If the client has health declarations, there is a tedious process of medical exams and tests done before a policy application is issued, postponed or declined.
Being informed is the best option one can have when getting a life insurance policy. Approval and denial of claims is dependent on all information declared during inception of the policy.
