Monday, February 27, 2017

How to Avoid Your Insurance Claims Being Denied.

Sometimes, people can get the image of insurance companies as money hungry corporate folk looking for any possible reason to deny all possible claims. Fortunately though, in the risk insurance market in New Zealand, that image doesn't hold true. The major reputable insurance providers that we deal with have a great record of paying out claims that are owed, provided they meet the specific conditions of the policy (which is why it's always a good idea to read the policy wording and know exactly what's covered).

In general, there are only a few reasons why your insurance claim could get denied, and as long as you avoid them, you can strongly depend on your insurance paying out when you need it during your difficult times.

1. Non-Disclosure: If you have a personal risk insurance policy and suffer injury or illness due to a condition you had prior to taking out your policy, and you failed to disclose this on your original applications, the insurance provider could reduce your claim or deny it entirely. We take considerable time with our clients to go through these forms and make sure every base is covered, but if you are going it alone, here are some things to keep in mind:

  • Declare everything, no matter how small or minute you may think it is. If the condition isn't deemed to be serious by the insurers, your policy won't be affected in any way by declaring these things.
  • Consult with your personal doctor or specialist first to remember any health issues you may have forgotten about.
  • It is never a good idea to lie about current health status (or not being a smoker) to save money on premiums. The insurance company will find out upon claims (they are generally thorough) and will reduce or deny your claim because of it.
  • You do not have to disclose conditions you develop after the policy is taken out and they will not affect the premiums you pay or any claims you take out. This is a good reason for you to consider taking out insurance when you are younger and healthier.
Proper and full disclosure may be the most important thing when taking out a policy.

2. Premiums Haven't Been Paid: An insurance policy is a contract between you and the insurer, which states that they will pay agreed upon amounts if its conditions are met. One of those conditions is the prompt and up to date payment of the agreed upon premium (the cost of the insurance policy). If the premiums haven't been paid up to date before the claim is formally requested, the insurance company may deny them or ask for payment before the claim is processed. Thus, its important not to get too far behind on your insurance payments as this is generally one of the only reasons claims get denied.

3. Conditions Have Not Been Met: If the specific condition or occurrence you're trying to claim for is not specifically covered under your policy, the claim will be denied. Sometimes a specific medical condition for instance can range in severity, and if the severity of your condition doesn't meet that specified in the policy, it won't qualify for a claim. The good news is, all of these details will always be specifically and thoroughly outlined in your policy wordings, so reading it thoroughly before, during and after taking out your policy is always highly recommended by our team.

In our more than two decades in the insurance industry we can assure you that insurance companies aren't looking to deny your claims. In return, their expectations of you are that you are honest, truthful and complete in your disclosures and maintain the agreed upon payments for the policy. If you have done so, you can rest assured that you will have very little to worry about when it comes time to make a claim.

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