Visit Our Page on How to Prevent Insurance Claim Rejection

 

Customers must fully grasp that the insurance they choose satisfies their needs before purchasing it.

Additionally, potential insurance clients must completely and truthfully fill out a Life Insurance Request Letter (SPAJ).

According to Himawan Purnama, Chief Product Officer of Allianz Life Indonesia, this was done to ensure that the insurance cover one acquired was appropriate for their health.

According to the policy agreement, customers will also find it simple to obtain health insurance cover, he added in an official statement that was cited on Sunday (21/5/2023).

Himawan offers advice on how to submit a claim in order to maximize the benefits of insurance protection for potential clients.

Here are some suggestions for how to submit an insurance claim without getting it denied.

1. Ensure prompt payment of premiums

The policy conditions can continue to adhere to the policy provisions by paying premiums on time, ensuring that clients continue to be protected.

2. Complete the SPAJ in an open and sincere manner.

The genuine health condition is what customers should share. Future disclosure of past medical histories or health issues that were not openly acknowledged is possible. This gives the insurance provider the authority to refuse because some circumstances are genuinely not covered by the policy or do not comply with its protective clauses.

A pre-existing condition is a medical history that must be openly stated if it was experienced prior to purchasing insurance.

The non-disclosure clause states that the insurance company has the authority to reject a claim if a customer submits one for a particular condition and it comes out that the customer has already experienced it.

3. Pay close attention to the exclusions and limitations that apply to the policy's coverage.

Depending on the type of insurance product policy, insurance plans include conditions. There are other provisions that need be taken into account, such the waiting period. This is the time frame necessary for the insurance policy's benefits to kick in.

For instance, a disease condition has a 12-month waiting time after the policy is put into effect. It excludes coverage when submitting a claim within that waiting period.

In addition, there is a survival period, which is the time frame in which the covered person lives from the moment he or she receives a critical disease diagnosis until they pass away.

The policy may be canceled and claims received within the survival period may be refused. Additionally, buyers must be aware of the policy's exceptions and limitations.

4. Documents' thoroughness

To ensure that the insurance company processes the claim, the necessary documentation must be provided.

5. False information or manipulation of medical problems

The insurance provider will look into any claims that were made. The claim will be rejected if it can be demonstrated that there is a discrepancy or an indication of a crime, such as misrepresenting a disease condition so that a payment can be made.

6. Be mindful of the deadline

Make that the reimbursement claim is not submitted after the deadline for filing claims has passed.

 

These are suggestions on how to submit an insurance claim without getting it denied.