Insurance company refuses to pay, what can they do?

[jerrymahoney]

8 minutes ago, Sheryl said:

P.S. the above applies only if it is a Thai-issued policy.

 

If foreign issued  then consult the policy dicuments which  will describe appeals procedure. 

 

From OP:

 

Needless to say it's a Thai company.

[Sheryl]

2 hours ago, jerrymahoney said:

From OP:

 

Needless to say it's a Thai company.

Ah yes.

 

So then easy matter to lodge a complaint with the OIC.

 

If the insurance company is in the wrong (cannot say on that as no details provided), simply filing a complaint with the OIC is often all it takes to get things quickly resolved.

 

OP have them open that link in Giigle chrome for translation as while the main OIC page comes in English the complaint form is only in Thai. They will need to first register with a password and email addy.

 

 

[Mac Mickmanus]

8 hours ago, 4MyEgo said:

My wife told me that if you have money here, you can buy the other sides lawyer easily.

What does your Wife say about this case in particular ?

[rabiedabruce]

4 hours ago, Liverpool Lou said:

No, they do not, "small print" is a myth, policies do have easily read conditions, though, that some people don't bother to read and when a claim is legally denied (because it wasn't covered from the start) the claimants call it "small print".

Wrong. I remember some music gig many years ago and they had a screen projector alongside with all the bad things foisted upon us, one was 'fine print'. This was twenty years ago, I never forgot it because it's TRUE.

[rabiedabruce]

22 minutes ago, Sheryl said:

Ah yes.

 

So then easy matter to lodge a complaint with the OIC.

 

If the insurance company is in the wrong (cannot say on that as no details provided), simply filing a complaint with the OIC is often all it takes to get things quickly resolved.

 

OP have them open that link in Giigle chrome for translation as while the main OIC page comes in English the complaint form is only in Thai. They will need to first register with a password and email addy.

 

 

What is OIC? And again, the husband is Thai, so no need for translation. This is not an 'asking for a friend' post, I genuinely wanted to help. But some of the replies reminds me of what I was told by a wise businessman many years ago 'Never try to help anyone'.

[rabiedabruce]

9 hours ago, zombie nights said:

OP: can you please clearly state the reasons why the Insurance company are refusing to pay?

I don't know but her husband home soon so I'll ask.

[Sheryl]

13 minutes ago, rabiedabruce said:

What is OIC? And again, the husband is Thai, so no need for translation. This is not an 'asking for a friend' post, I genuinely wanted to help. But some of the replies reminds me of what I was told by a wise businessman many years ago 'Never try to help anyone'.

Office of the Insurance Commission

 

the body that regulates all types of insurance, and insurers, in Thailand.

 

And the place to lodge a complaint, which can be done online.

 

 

[rabiedabruce]

3 hours ago, Sheryl said:

P.S. the above applies only if it is a Thai-issued policy.

 

If foreign issued  then consult the policy dicuments which  will describe appeals procedure. 

 

I've just seen him and given the link previously posted about the OIC. Thanks everyone. I'm out.

[Liverpool Lou]

40 minutes ago, rabiedabruce said:

This was twenty years ago

That was twenty years ago.  This is today!  "Fine print" does not exist in insurance policy conditions...insurance policy conditions do.

[Dah fahrang]

Sounds to me like they're refusing to pay by using the ubiquitous loophole of 'pre-condition'. 

All policies have this in the "small print". They are claiming (I think) that your wife had this pre-condition before taking out insurance, they are not liable to pay.

The burden of proof lies with you, I fear. 

[Liverpool Lou]

7 hours ago, rabiedabruce said:

The wife's pretty smart and would've checked the policy.

Apparently not.

[Sheryl]

1 hour ago, Dah fahrang said:

Sounds to me like they're refusing to pay by using the ubiquitous loophole of 'pre-condition'. 

All policies have this in the "small print". They are claiming (I think) that your wife had this pre-condition before taking out insurance, they are not liable to pay.

The burden of proof lies with you, I fear. 

As others have said, there is no fine print.

 

It is not his wife but the wife of a friend.

 

And we have no way of knowing what the issue is (and seems OP also does nto know), best not to make any assumptions. If as was initially said they have had the policy for 5 years it seems unlikely to be on grounds of pre-existing unless there is clear past history. 

 

But we really have no idea. I have known over the years people to make reports oif "insurer will not pay" and it later turns out:

 

- the insurer is awaiting documentation from the hospital which had nto been sent (if this is Vachira hospital - as it may be from the suggestion that cost only 300k -- then it likely will never arrive).

 

- the insurer would pay but not directly, only on reimbursement basis (this is more common with travel policies and with government hospitals which do not have direct pay arrangements with insurers)

 

- the insurer would pay but has an issue with the cost estimate provided, or will not pay the full costs because they exceed policy limits

 

-- there is a clear exclusion in the policy which this falls under

 

and many, many more things.  We Simply have no way of knowing what this specific issue is.