is there a health insurance regulator in thailand

[beaufoy]

Due to dubious conditions on my thailand health insurance I decided to cancel said policy. Now in England I could contact a regulator to get a refund of the money I paid to the insurance company or go to the small claims court ......What can I do in Thailand?

[Etaoin Shrdlu]

Your policy should contain wording that explains how refund premiums will be calculated in the event a policyholder cancels mid-term. Usually this is some form of "short rate" calculation which results in less than a pro-rata return premium. One would normally correspond directly with the insurer to cancel and obtain a refund of premium.

 

The Office of the Insurance Commissioner (OIC) is the regulator for insurance in Thailand. The OIC has the ability to mediate disputes between consumers and insurers. Here's a link to the relevant website: https://www.oic.or.th/en/complaint

 

The OIC is generally consumer-friendly and you would get a fair hearing if you have a complaint. Best to have a Thai-speaker help you with your interactions with the OIC

[proton]

Good luck with that, our insurance company went bust 2 years ago and it was backed by a Government guarantee, we never got anything back and no response to emails, phone calls or letters.

[Felton Jarvis]

I suspect that any sort of "regulator" would be charged with making sure that the insurance company makes a profit.  The prices for health insurance are totally out of line with the costs of health care. If the industry were truly regulated, the premiums would reflect that.

[thailand49]

" Small Claims Court "  🤣

There is a Insurance Commision in theory but caution like everything

" The light is on but no one is home" 

[beaufoy]

2 hours ago, thailand49 said:

" Small Claims Court "  🤣

There is a Insurance Commision in theory but caution like everything

" The light is on but no one is home" 

I do not know the OIC and if it really regulates however I have had experience of regulators in Ireland and they tend to support the service providers they pretend to regulate rather than the customers.....I have had experience of Small claims in England and they are far from perfect but I would say the if a consumer puts a very strong case against a service provider in small claims court he will have double the chance of a fair result in the court than he would using the regulator.

      Now comes the question " If I use the OIC and fail am i still allowed to take action in the small claims court?"

[Sheryl]

12 hours ago, beaufoy said:

I do not know the OIC and if it really regulates however I have had experience of regulators in Ireland and they tend to support the service providers they pretend to regulate rather than the customers.....I have had experience of Small claims in England and they are far from perfect but I would say the if a consumer puts a very strong case against a service provider in small claims court he will have double the chance of a fair result in the court than he would using the regulator.

      Now comes the question " If I use the OIC and fail am i still allowed to take action in the small claims court?"

Making a complaint to the OIC in no way precludes subsequent legal action.

 

The OIC is consumer-friendly.

 

It is also inclined to be very literal with respect to insurance contract provisions. If your insurance policy states that all or part of premium is refundable, and you went through the prescribed procedure to request refund, OIC will require that the insurer issue the refund.

 

Often as soon as insurer learns you made a complaint to the OIC, that is all it takes to spur them into action. (Provided of course your are entitled to a refund under the terms of the policy).

[beaufoy]

13 hours ago, Sheryl said:

Making a complaint to the OIC in no way precludes subsequent legal action.

 

The OIC is consumer-friendly.

 

It is also inclined to be very literal with respect to insurance contract provisions. If your insurance policy states that all or part of premium is refundable, and you went through the prescribed procedure to request refund, OIC will require that the insurer issue the refund.

 

Often as soon as insurer learns you made a complaint to the OIC, that is all it takes to spur them into action. (Provided of course your are entitled to a refund under the terms of the policy).

With my limited legal knowledge and very little experience in writing terms of a contract. I can still write a contract which would cause 50% (I suspect an insurance company can take it from 50% to 90%)of good claims to not reach the standing of a good claim. I can also hide unfair (not having to recognizing expert doctor report) terms of contract in the small print and then highlight said terms when refusing a claim, or asking for more money, or insisting on more tests that the doctor says are not required

[Sheryl]

10 hours ago, beaufoy said:

With my limited legal knowledge and very little experience in writing terms of a contract. I can still write a contract which would cause 50% (I suspect an insurance company can take it from 50% to 90%)of good claims to not reach the standing of a good claim. I can also hide unfair (not having to recognizing expert doctor report) terms of contract in the small print and then highlight said terms when refusing a claim, or asking for more money, or insisting on more tests that the doctor says are not required

I haven't seen any policies with "small print".

 

As your thread is about getting refund of your premium after cancellation: what are the policy conditions for that?  And do you have proof you notified company of cancellation and requested refund?

 

As this is what it will come down to. 

[beaufoy]

9 hours ago, Sheryl said:

I haven't seen any policies with "small print".

 

As your thread is about getting refund of your premium after cancellation: what are the policy conditions for that?  And do you have proof you notified company of cancellation and requested refund?

 

As this is what it will come down to. 

I worked at an insurance company in England and we used small print

Do you understand my initial post on this thread....It would seem you believe i just got bored of having insurance and decided to cancel the policy......try reading again you might notice that i might have serious reason for cancelation, but do not want to divulge said reason on this forum....

[Sheryl]

31 minutes ago, beaufoy said:

I worked at an insurance company in England and we used small print

Do you understand my initial post on this thread....It would seem you believe i just got bored of having insurance and decided to cancel the policy......try reading again you might notice that i might have serious reason for cancelation, but do not want to divulge said reason on this forum....

I fully understand the bit about wanting to cancel. I actually advise people against getting Thai-based policies.

 

Nonetheless your OP stated what you seek is refund of premiums paid, having cancelled your policy. No mention of a claims dispute, just refund of premiums, So my questions stand:

 

what are the policy conditions for that?  And do you have proof you notified company of cancellation and requested refund?

 

 

 

 

[beaufoy]

On 10/21/2023 at 5:43 PM, thailand49 said:

" Small Claims Court "  🤣

There is a Insurance Commision in theory but caution like everything

" The light is on but no one is home" 

 

Hello Thailand 49 two points I wish to receive your advice on

1) My present intentions are to make a complaint to the insurance commission and if/when that fails go to the small claims where I suspect I will have a 50/50 chance of winning

2) I know this makes me sound like a multiple litigator but I will explain in 2021 I had to cancel a qatar airways flight because my wife's thailand certificate for entry was late in arriving. Qatar airways said my circumstances gave me rights to a full refund and I would receive said refund within one month. However, several months later and they were giving silly excuses for not giving a refund. Then they tried the trick of saying I was being very rude when writing e mails asking for a refund (which was six months late) and they no longer wished to answer my e mails.  I tried different routes airway complaints regulator and other avocates but none worked. Then I made an enquiry on a FOI and was told on a legal advice webb site that Qatar air do not allow FOI but I could make a request for copies of all e mails written within the company pertaining to my complaints. I did as advised and then Qatar started writing again suggesting that if I cancel my copy of e mails request then they would re-open my refund request. I did not retract my copy of all e mail request and a few days later the refund was paid.....obviously they did not want me to see e mails they had writen to other people in the company

  Now my question:  The person writing e mails to me obviously is not too confident dealing with me and includes other people in her company to receive my e mails......So if I could make a request for FOI or copies of all e mails written about me it might cause the company embarrassment and help my case........any advice please

[Sheryl]

The Official Information Act 1997 in Thailand pertains only to government entities. I am not aware of any Thai law that would enable you to  obtain internal emails from a private company. Police can of course get such if it is part of a criminal complaint (and they trouble to seek it) but as a civil litigant I do not think you can.

 

If as you stated in your OP you are seeking only refund of premiums then >95% chance complaint to OIC will resolve it, subject of course to policy provisions. If you are seeking more of a refund than policy terms allow for, you will not get that through OIC and very, very unlikely to get it in court either.

 

If contrary to your OP there is more in dispute than premium refund (e.g. a claims dispute) then resolution through OIC is more iffy but I would still give it at least 50-60% odds. The problem is that OIC is good at enforcing contractual terms of a policy but lacks any medical expertise (so too do most Thai health insurers which is  often part of the problem to begin with).

 

However just knowing you have lodged a complaint with OIC will often be enough to spur an insurance company to settle with you as they do not want OIC  investigation. Contrary to what some posters here have assumed, OIC is not on a cozy basis with the insurers but rather very much in a regulatory role and they fear it.

 

[thailand49]

3 hours ago, beaufoy said:

 

Hello Thailand 49 two points I wish to receive your advice on

1) My present intentions are to make a complaint to the insurance commission and if/when that fails go to the small claims where I suspect I will have a 50/50 chance of winning

2) I know this makes me sound like a multiple litigator but I will explain in 2021 I had to cancel a qatar airways flight because my wife's thailand certificate for entry was late in arriving. Qatar airways said my circumstances gave me rights to a full refund and I would receive said refund within one month. However, several months later and they were giving silly excuses for not giving a refund. Then they tried the trick of saying I was being very rude when writing e mails asking for a refund (which was six months late) and they no longer wished to answer my e mails.  I tried different routes airway complaints regulator and other avocates but none worked. Then I made an enquiry on a FOI and was told on a legal advice webb site that Qatar air do not allow FOI but I could make a request for copies of all e mails written within the company pertaining to my complaints. I did as advised and then Qatar started writing again suggesting that if I cancel my copy of e mails request then they would re-open my refund request. I did not retract my copy of all e mail request and a few days later the refund was paid.....obviously they did not want me to see e mails they had writen to other people in the company

  Now my question:  The person writing e mails to me obviously is not too confident dealing with me and includes other people in her company to receive my e mails......So if I could make a request for FOI or copies of all e mails written about me it might cause the company embarrassment and help my case........any advice please

Sorry your comment and situation requires legal advice in which Im not qualified to give.

[beaufoy]

On 10/24/2023 at 8:49 AM, Sheryl said:

The Official Information Act 1997 in Thailand pertains only to government entities. I am not aware of any Thai law that would enable you to  obtain internal emails from a private company. Police can of course get such if it is part of a criminal complaint (and they trouble to seek it) but as a civil litigant I do not think you can.

 

If as you stated in your OP you are seeking only refund of premiums then >95% chance complaint to OIC will resolve it, subject of course to policy provisions. If you are seeking more of a refund than policy terms allow for, you will not get that through OIC and very, very unlikely to get it in court either.

 

If contrary to your OP there is more in dispute than premium refund (e.g. a claims dispute) then resolution through OIC is more iffy but I would still give it at least 50-60% odds. The problem is that OIC is good at enforcing contractual terms of a policy but lacks any medical expertise (so too do most Thai health insurers which is  often part of the problem to begin with).

 

However just knowing you have lodged a complaint with OIC will often be enough to spur an insurance company to settle with you as they do not want OIC  investigation. Contrary to what some posters here have assumed, OIC is not on a cozy basis with the insurers but rather very much in a regulatory role and they fear it.

 

Hello everybody again i have tried phoning the OIC using all the phone numbers as being forms of contact.I get phone not in operation or engaged. there is an online inquiry form which i completed a week ago and received the message that it was delivered, but as yet no answer

 

I will not yet say which insurance firm it was, but the main complaints were they told me I must have a colonoscopy because the hospital found blood in my stool. They admitted they did not ask for a full report so I obtained one for them

 Said report said the blood was caused by my hemorrhoids and there was no need for another examination or a colonoscopy. I sent said report to the insurers and they replied they insist on a colonoscopy for every person who shows blood in their stools. Now I find said policy disgusting, and it makes me less confident because the same thing can happen in reverse ie I could be admitted to a hospital with a suspect heart attack and the doctor might say you need a bypass. However, because the health insurance does not respect the Doctors they might say we think you should just take medication for your heart problems.    Now let us look at the endorsement they put on my policy. The actual endorsement suggests the endorsement expires after 2 years, so if I wait out the two years full cover will be restored, but the after thought says even if I wait out the two years I still have to take a colonoscopy

text within the endorsement

Investigation and treatment of all gastrointestinal (GI) Bleeding GI Malignancies,GI Polyps and their causes and complications are not covered for a period of 2 years, or the submission of recent gastroscopy and colonoscopy reports. At the end of the waiting period, or the satisfactory review of recent gastroscopy and colonoscopy reports this condition will be reassessed . Charges for gastroscopy and colonoscopy are not covered during the waiting period

 

 Text added after the endorsement 

And If you refuse to submit the requested examination then the Underwriting Department will maintain the condition for another year. Or you can submit it later.

 

Yours sincerely,

[Sheryl]

I thought you said the issue was that you had canceled the policy and wanted a refund??

 

An insurer has the right to exclude conditions  and/or request additional docunentation  as they see fit. Up to you to acce0t or reject the policy offered.

 

I don't see anything OIC could address here. They mainly just insure fhat terms of the policy are respected.

 

 

 

 

[beaufoy]

On 11/11/2023 at 10:36 PM, Sheryl said:

I thought you said the issue was that you had canceled the policy and wanted a refund??

 

An insurer has the right to exclude conditions  and/or request additional docunentation  as they see fit. Up to you to acce0t or reject the policy offered.

 

I don't see anything OIC could address here. They mainly just insure fhat terms of the policy are respected.

 

 

OK then look at this scenario when I had the medical the doctor found blood in my stool, and examination of the blood suggested it was caused by hemerroids and there was nothing to worry about. Hence I did not worry about the possibility that ------- Health would change my policy. Hence when I did not receive notification of endorsement I thought everything was OK .....When I was told about the endorsement two years premiums had been paid and I was told I could cancel but I would not be refunded the money

 

[Sheryl]

"OK then look at this scenario when I had the medical the doctor found blood in my stool, and examination of the blood suggested it was caused by hemerroids and there was nothing to worry about. Hence I did not worry about the possibility that ------- Health would change my policy. Hence when I did not receive notification of endorsement I thought everything was OK .....When I was told about the endorsement two years premiums had been paid and I was told I could cancel but I would not be refunded the money"

 

If I understand you correctly, on policy renewal they added an exclusion that was not in the original policy based on new finding. Unfortunately this is something Thai insurers are allowed to do, one of several reasons why I always recommend against Thai based policies.

 

If by "would not be refunded the money" you mean for the  prior two years, of course not as that period has passed and you were insured (without endorsement) during it. If you mean that you want a refund of the current new period for which you have already paid (example: you paid for coverage for 1 year and you are now just 1-2 months into that 12 month period) that should be refundable.

 

 

[beaufoy]

6 hours ago, Sheryl said:

"OK then look at this scenario when I had the medical the doctor found blood in my stool, and examination of the blood suggested it was caused by hemerroids and there was nothing to worry about. Hence I did not worry about the possibility that ------- Health would change my policy. Hence when I did not receive notification of endorsement I thought everything was OK .....When I was told about the endorsement two years premiums had been paid and I was told I could cancel but I would not be refunded the money"

 

If I understand you correctly, on policy renewal they added an exclusion that was not in the original policy based on new finding. Unfortunately this is something Thai insurers are allowed to do, one of several reasons why I always recommend against Thai based policies.

 

If by "would not be refunded the money" you mean for the  prior two years, of course not as that period has passed and you were insured (without endorsement) during it. If you mean that you want a refund of the current new period for which you have already paid (example: you paid for coverage for 1 year and you are now just 1-2 months into that 12 month period) that should be refundable.

 

 

I have been employed in the insurance sector in England, although I was employed in motor claims, I believe the health insurance sector was able to amend the extent of cover after the joining  medical examination found the insured was suffering from a condition ie the english insurance company could and did and should of added an exclusion. However, a situation then exists which falls into 3 sections

1) The insured wants to keep full cover

2) The insurance company wants to take advantage of the "found by doctor's condition' to reduce the cover as much as possible ie Hemmerrroid blood is found so all bowel problems excluded

3) The Hospital Doctors believe an adjustment in cover based on the findings of the doctor is correct

      Now to your second paragraph in which you say I was insured without endorsement during the first two years, in fact there was an endorsement, but the insurance company failed to inform me of said endorsement. This is the point where I have to explain the uk/usa  rule " The insurance company must bring to the attention of the insured any changes which might effect the insured"

In fact I will quote another rule " If evidence in each direction is equal then the court should decide in favor of the insured"

     Of course rules/laws are written in a way to benefit the consumers, but the law courts usually work in the opposite direction, and there is another hurdle Thai Law usually follows UK/USA law, but it might not in my case.

       My case is that for most of the two years I was not receiving what i had paid for ie full cover, and I was not informed that I was not receiving full cover. Hence the insurance company was in breach of contract and is obligated to refund the payments received for said period of time.......Yippee I won

       Now comes the problem in that the insurance company did post notification of endorsement and it was sent recorded delivery, but the receptionist signed for the letter and then lost the letter.....

  Now obviously the insurance company did not fullfill their obligation to bring my attention to the notice of endorsement, but i suspect they will tell the judge that they made every reasonable attempt to do so.....Then it will be up to the judge to decide and he will decide it is a 50/50 case  so by way of my second rule he should find in my favor