Health insurance may be the most important type of insurance a person can get. In a worst case, it is possible to replace a car, home, or piece of furniture. You’re stuck with the body you have, though: if it fails or if you are injured in some way, insurance is your only real assistance. Not only that, health insurance is also directly related to your occupation and earnings. Nearly all jobs require at least some degree of physical fitness – even sat at a desk all day like me. If your health is impaired, your career and financial security could be harmed as well. With this in mind, many Britons go beyond relying on the National Health Service to purchase private insurance. This is because private insurers usually imply speedier, better-quality care than one might expect from the NHS – the politician’s numerous pro-NHS speeches aside.
Nevertheless, consumer advocate group Which? reports that since 2005, health insurance claim rejections have run at about 20% per year, a figure repeated in a great many other British media sources. To put a human face on this statistic, however, we summarise below a few stories of health insurance rejection cases, as reported in the Guardian, thisismoney.co.uk, and other media.
Tony Upjohn (42), Thrapston, Northants: Mr. Upjohn continues a court dispute over a permanent disability claim against Scottish Provident.
Jacqueline Bradburn (46), Llanymynech, Powys: Ms. Bradburn won her critical illness claim (cancer) only after a yearlong struggle against Legal and General.
Michael Jowitt (54), Yorkshire: Mr. Jowitt continues a Permanent Health Insurance (PHI) claim fight against Swiss Re.
The three cases involve lengthy and complex legal arguments on both sides, and all three cases are different in important ways. However, there are similar threads running through all three cases as well. They provide tips to policyholders who may have to make a claim one day.
1) Be honest when you sign up for insurance: Inform your insurer of any health problems you either know you have OR can “reasonably suspect” that you have (e.g. if you’ve got an in-growing toenail you should probably declare it because showing up at the private health clinic the following day adamantly stating that it “wasn’t there yesterday” probably won’t fly). Which? reports that 25% of critical illness reports are commonly rejected because of failure to disclose health issues at the time coverage was signed up for. Don’t count on hiding a condition you know you have: as we’ve written before, modern medical techniques often allow a medical illness to be backtracked to a point where the policyholder must have been aware of it.
2) Keep your insurer medically updated: Inform your insurer of any medical change or treatment you undergo, even if it seems minor. Ms. Bradburn’s claim rejection was initially based upon treatments she had for depression and an eye problem. The treatments may have seemed trivial and completely unrelated to cancer. Nevertheless, the insurers were able to build a case on these. To avoid this, there can be no harm in informing your insurer, if only by email, any time you see a doctor. If you don’t, you might unwittingly open up legal space for them to deny your claim later. At the very least, get something in writing from them stating what information you need to provide in regards to future doctor/hospital visits.
3) Comprehend a policy thoroughly: Insurers will stick to the fine legal print if a claim is made, and will interpret it in their favour to the maximal extent. The larger the potential payout, the closer they will probably stick to the fine print. Medical terminology can be especially confusing, so make a special effort to study the policy coverage very carefully before you sign. Ask the insurer if you are unsure about anything, even a small point: the time to ask is before you sign up. The same goes if you are buying online; don’t just click though, but read the coverage terms carefully.
I recently purchased health insurance through Norwich Union*, and deep into the several documents that came through the post was the statement that they do not cover “medical appliances”. What did that mean? Well, apparently it means items like crutches. Why they didn’t just state a few examples I have no idea and the individual I phoned, though very helpful, had no idea either and had to physically go to the claims department to ask what that statement meant. Such strange and vague wording is commonplace.
Lawyers write policies, not nodding dogs or cartoon elephants.
* not given as an endorsement
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