Insurance Claims Denied, Here Are 5 Reasons!

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The difficulty of managing insurance claims is often a separate scourge for insurance policy holders. Not a few also make it a reluctance to buy an insurance policy, be it health insurance, car insurance or travel insurance. But the difficulty of managing the claim is not without reason. Everything is in agreement between the insurance company and the buyer of the insurance policy, and is legally bound. That is, claims will not be arbitrarily rejected.

Here are 5 reasons for your insurance claim being rejected:

1. Policy is inactive (Lapse)
Insurance policies can be inactive due to a number of circumstances. This inactive condition is also called lapse. The insurance company is not willing to pay insurance claims if the policy is lapse. Here are two examples of the condition of the policy being carried out and making your insurance claim rejected.

Payment of insurance premiums is due because it has passed the grace period. Each insurance may have different grace times. Usually a maximum of about 45 days. If an event occurs after that period, the insurance will not be held responsible for any losses suffered by policyholders, even if included in the policy clause. Pay insurance premiums on time or at least not until the end of the grace period.

If the insurance policy is in the form of unitlink, the policy can be considered lapse if the cash value of insurance is not enough to cover insurance costs. At least there are two causes of insufficient cash value, namely investment performance is not good and cash value is often disbursed. To avoid this, it's a good idea to top up at a certain time when investment performance is bad. In addition, make sure not to cash out the cash value, except at any time in a state of urgency.


2. Claims Not Included in the Clause
The insurance policy contains an agreement that includes what criteria are included and not included in the insurance coverage. In TLO car insurance, what is meant by severe damage may vary from one insurance to another. It could be at least 70%, 75%, even 80%. So, insurance will not cover the cost of damage, if the damage does not reach the agreed percentage.

We take another example. For example, the policy states that stroke is a cerebral-vascular attack, permanent neurological, in more than 24 hours. Even if the doctor diagnoses a policy holder with a stroke but is still less than 24 hours, the insurance claim cannot be submitted because it will certainly be refused.

3. Submission of Claims Exceeding the Specified Time
Insurance claims can be delayed or even rejected if the management of a claim exceeds the time specified in the policy. Insurance always gives a certain time limit for handling claims. Passing from that, the claim can be rejected. Car insurance claims must be taken care of immediately because the deadline is short, only 3 x 24 hours. While for insurance such as life insurance, the deadline is between 30-60 days.

4. Incomplete Claim Document
Be sure to know all the documents that must be provided when you want to submit a claim. One document is lacking, insurance will reject the claim. For example for life insurance, a certificate from a doctor is needed. You are also required to fill out a claim form.

Follow the procedure correctly. If the claim is a car insurance claim, be sure to take a photo of the car's damage. This photo will be one proof when you want to submit a claim to insurance.

Then prepare complete documents, starting from photocopies of insurance policies, photocopies of SIM and STNK, and of course the claim submission form. A certificate from the police may also be needed if serious damage occurs.

Completely filling out the form, fill it honestly and as clearly as possible because the insurance will later check. They will not pay claims if the contents of the claim form prove to contain lies.

Another important procedure is to make repairs at the partner workshop. The same thing also includes treatment at a hospital referred to by insurance. May not repair or seek treatment outside the insurance reference.


5. Being in the Waiting Period
In certain types of insurance, there is usually a policy called the waiting period. The buyer of the insurance policy will not be able to submit a claim if it is in the waiting period. For critically ill people, there will usually be a waiting period of around 30 to 365 days.


Say a waiting period of around 30 days. The insurance policy was purchased on February 1, 2015. Then he suffered a critical illness on March 1, 2015. If he made a claim, the insurance would reject it, because it had not passed the waiting period.

Source : https://www.cermati.com/artikel/klaim-asuransi-ditolak-ini-10-alasannya


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