Insurance Scam

[HeijoshinCool]

I returned to LOS last December. The insurance I purchased was full coverage.

 

In February, I experienced some health issues and went to Bumrungrad. The hospital was excellent in providing all the paperwork for the insurance claim.

 

I supplied all the forms required by the insurance agency within a few days. All my communications were cogent and polite.

 

The runaround then began, and I was passed from person to person, none of whom appeared reasonably competent in English, and as of the first week of August, they have become incommunicado. It's only about $600, but it pisses me off just on principle. They collect premiums from us, but make no claim payouts. 

 

With whom (government agency) can I file a complaint?

 

EDIT: If you'd like "more info" feel free to PM me ????

Edited August 21, 2021 by HeijoshinCool

[dj230]

This is why I'd rather pay more for a reputable company, at least it was just $600 and not a huge bill

[BritTim]

I am glad to see you do not name the company, if it is a Thai company. Publishing any information that makes a Thai person or company look bad (whether truthful or not) can get you into a world of hurt.

 

Make sure you keep every detail of you communications with the company. If this was by phone, keep notes on the person you spoke with, together with date and time.

 

I applaud your desire to go after them, but the only official body that could in theory help would be the police. They will only possibly act if there is strong evidence of actual fraud. This is a high bar to satisfy. Generally in Thailand you are expected either to write off the loss, or take civil action.

 

I believe it is worth your while at this stage to pay a cheap lawyer to send the company a solicitor's letter threatening legal action and the resultant publicity if they do not pay up. That is cheap, and might do the trick. If they still do not budge, you will need to decide whether to proceed with very time consuming legal proceedings that you would likely win but would probably cost more than the money you recover. If you do decide to go ahead, consider setting up a GoFundMe page for support in your public interest legal action.

[Etaoin Shrdlu]

You might wish to contact the Office of the Insurance Commissioner. Part of their remit is to resolve issues between policyholders and insurance companies. The OIC is generally quite consumer-friendly and you should get a fair hearing.

[NanLaew]

I was on a recent hunt for insurance and delved deep into the small print of a 'reputable' company in that they are frequently mentioned and recommended in insurance query threads. I saw that they had a 36-month 'waiting period' that may apply when it comes to their determination of pre-existing conditions. That suggested to me that after a decent 18 or 24 months of being healthy with no claims, if one has the misfortune to require treatment for any one of the typical medical conditions that come with age, they could easily decline to pay anything. If a surgical procedure was needed, that could be a considerable expense.

 

What does the OP's policy small print say?

 

With respect to @BritTim's advice, I understand that the Thai insurance ombudsman has a good track record on holding the recalcitrant p(l)ayers feet to the fire. Maybe a first step before engaging a lawyer?

[Sheryl]

OP: how to complain depends on what country the insurer is based in.

 

If Thailand here is the link to make a complaint to the Office of Insurance Commission. Can be done online

https://complaintportal.oic.or.th/ppms/login

 

only in Thai, try pasting it into google chrome

 

The OIC is usually very helpful and there is n o cost to filing a complaint with  them. A lawyer on the other hand will cost you far more than it is worth and, in Thailand, is likely to be of little help.

If it is an international insurer then read your policy as it will state steps to take with a complaint

 

Before filing complaint, check your policy regarding time in which claims are supposed to be processed. It should say. Compare this to amount of time that has elapsed. Since they have not denied your claim, just not paid it yet, this will form the basis of your complaint.

[Sheryl]

1 hour ago, BritTim said:

 

....Iapplaud your desire to go after them, but the only official body that could in theory help would be the police.

 

This is not  the case. The OIC is specifically set up to oversee insurance companies  sort of thing and has a readily accessible on-line complaint submission function.

 

There are similar bodies in other countries as well.  So depending on where OP's insurer is based, he can readily file a complain, and at n o cost.

 

Police will not have the slightest interest in the matter nor would they be able to determine whether an insurance company has fulfilled its contract - that needs an entity familiar with policy wording and insurance law.

 

 

[HeijoshinCool]

4 hours ago, dj230 said:

This is why I'd rather pay more for a reputable company, at least it was just $600 and not a huge bill

.

 

Large, well-established Thai company that came highly recommended by other expats. 

[HeijoshinCool]

2 hours ago, Sheryl said:

If Thailand here is the link to make a complaint to the Office of Insurance Commission. Can be done online

https://complaintportal.oic.or.th/ppms/login

 

only in Thai, try pasting it into google chrome

.

 

I speak and type in Thai, so no problem. Thanks for the link. 

 

I knew there had to be a government organization that fit the bill. 

[dj230]

8 minutes ago, HeijoshinCool said:

.

 

Large, well-established Thai company that came highly recommended by other expats. 

You said they don't even have English speaking customer service? That's a red flag for me, any well established healthcare company is going to have English speaking customer service.

 

Edited August 21, 2021 by dj230

[alyx]

9 minutes ago, dj230 said:

You said they don't even have English speaking customer service? That's a red flag for me, any well established healthcare company is going to have English speaking customer service.

 

Agreed but... I do not understand this OP's remarks as it is also stated that the OP "speaks and type in Thai",,,I am confused

[HeijoshinCool]

I never advertise my ability to speak Thai, especially when doing business. I find such a practice has many benefits, and I have no ego that needs stroking anyway. 

 

I did not say they don't have English speaking CS. What I said in my original post was that none none of them "appeared" competent in English. I have found, over the years, that some Thai companies use that to pretend not to understand, hoping to frustrate the customer until he gives up. That is why I wanted to know about any insurance commission. Let them deal with it based on all the documents I will provide them, some of which are damning.

 

I never discuss things on the phone unless absolutely necessary. Business 101, fellas, emails or letters, physical documents that can't be deleted or denied.

[scubascuba3]

I saw a case recently where the insurer cancelled the whole insurance because they said the customer didn't declare a pre-existing condition, which is arguable anyway, sometimes court action is required

[Etaoin Shrdlu]

1 hour ago, scubascuba3 said:

I saw a case recently where the insurer cancelled the whole insurance because they said the customer didn't declare a pre-existing condition, which is arguable anyway, sometimes court action is required

This is an issue that everyone needs to understand. If the pre-existing condition would have caused the insurer to reject the application for insurance prior to the issuance of the policy, the insurer is within its rights to cancel and deny any claims submitted, regardless of whether the claims were for the pre-existing condition in question. All the insurer would need to do would be to prove that its underwriting guidelines would have called for rejection of the application had the condition been disclosed. Full disclosure at the time of application is necessary in order to avoid potential issues like this. If there is doubt as to whether disclosure would have caused the insurer to reject the application and thus cancel the policy, then the OIC or the country/state's regulator would be a good place to start the complaint process.

[ubonjoe]

Not visa or extension related. Moved to the Insurance in Thailand forum.

[ezzra]

4 hours ago, HeijoshinCool said:

I never discuss things on the phone unless absolutely necessary. Business 101, fellas, emails or letters, physical documents that can't be deleted or denied.

Well, so far it seem that your methods aren't working are they now? asking to speak to the manger and conversing with him in Thai would probably stop the charade of playing stupid one you will tell the manger that you intend to take the matter with the OIC.. Try is and see how it goes...

[HeijoshinCool]

2 hours ago, ezzra said:

Well, so far it seem that your methods aren't working are they now? asking to speak to the manger and conversing with him in Thai would probably stop the charade of playing stupid one you will tell the manger that you intend to take the matter with the OIC.. Try is and see how it goes...

.

Sure, and that's when "misunderstandings" are claimed.

 

No thanks, I like documents with statements made by those seeking to damage me. 

 

 

[dj230]

8 hours ago, HeijoshinCool said:

I never advertise my ability to speak Thai, especially when doing business. I find such a practice has many benefits, and I have no ego that needs stroking anyway. 

 

I did not say they don't have English speaking CS. What I said in my original post was that none none of them "appeared" competent in English. I have found, over the years, that some Thai companies use that to pretend not to understand, hoping to frustrate the customer until he gives up. That is why I wanted to know about any insurance commission. Let them deal with it based on all the documents I will provide them, some of which are damning.

 

I never discuss things on the phone unless absolutely necessary. Business 101, fellas, emails or letters, physical documents that can't be deleted or denied.

And this exactly solidifies my point, which was, that this doesn't sound like a "Large, well established company". If it was, wouldn't it have customer service that "appeared" competent in English?

[HeijoshinCool]

7 hours ago, dj230 said:

And this exactly solidifies my point, which was, that this doesn't sound like a "Large, well established company". If it was, wouldn't it have customer service that "appeared" competent in English?

It is one of the largest, if not largest,  well-established companies in LOS, located in Lumpini.

 

[1FinickyOne]

sorry for your troubles but all too easy to believe... sometimes I think a denial is built into the system.. I tend to self-insure. 

[HeijoshinCool]

1 hour ago, 1FinickyOne said:

sorry for your troubles but all too easy to believe... sometimes I think a denial is built into the system.. I tend to self-insure. 

So do I, as I am in great health. But this was the required covid insurance for re-entry.

[scubascuba3]

9 hours ago, HeijoshinCool said:

So do I, as I am in great health. But this was the required covid insurance for re-entry.

Last resort, a lawyer letter, you'd win easy