Statistics for Health Insurance payouts?

[JeffersLos]

Are there statistics available that show which health insurance companies are the best for paying out?

 

For example, Company XYZ covered 82% of all personal health insurance claims in 2023. Company ABC covered 63% of all personal health insurance claims in 2023.

 

It is in regards to personal health insurance in Thailand. 

 

TIA. 

[flyingtlger]

Haven't seen any statistics for health insurance in Thailand but health insurance companies are notorious for looking for any excuse to pay as little as possible....

 

Edited February 6 by flyingtlger

[scubascuba3]

Good idea but the companies won't be in favour of that, too easy to highlight the bad companies

[JeffersLos]

2 hours ago, flyingtlger said:

health insurance companies are notorious for looking for any excuse to pay as little as possible....

 

Yes, that's the point of trying to get stats about which ones are the most reliable for paying out.

 

There's not much put in paying for health insurance for 15 years, then getting a serious illness and they refuse to pay on some technicality. 

[Etaoin Shrdlu]

First it would be necessary to control for the claims that are clearly not covered by the policy terms and conditions or are fraudulent. Then also for cases where the policyholder did not abide by his or her obligations under the terms of the policy or failed to make full disclosure at the time of application. Some people consider these to be "technicalities" or "fine print", but are actually essential elements of insurance and insurers are within their rights to deny claims for these reasons and can be expected to do so. 

 

 

 

 

[jerrymahoney]

8 minutes ago, Etaoin Shrdlu said:

First it would be necessary to control for the claims that are clearly not covered by the policy terms and conditions or are fraudulent. Then also for cases where the policyholder did not abide by his or her obligations under the terms of the policy or failed to make full disclosure at the time of application. Some people consider these to be "technicalities" or "fine print", but are actually essential elements of insurance and insurers are within their rights to deny claims for these reasons and can be expected to do so. 

Sure and there have topics on here to wit:

 

If I don't declare a pre-existing condition, how can the insurer found out when I put in a claim?

[noobexpat]

4 hours ago, jerrymahoney said:

If I don't declare a pre-existing condition, how can the insurer found out when I put in a claim?

 

What a loophole you've just uncovered. Genius.

[CartagenaWarlock]

5 hours ago, JeffersLos said:

There's not much put in paying for health insurance for 15 years, then getting a serious illness and they refuse to pay on some technicality. 

Health insurance companies most likely won't refuse to pay customers with them for fifteen years. 

[Celsius]

you can't even get sold property prices in this country and you expect Thai insurance companies to disclose this data?

[JeffersLos]

3 hours ago, CartagenaWarlock said:

Health insurance companies most likely won't refuse to pay customers with them for fifteen years. 

 

They will is the T&Cs have been breached. 

 

None of the T&Cs have time statutes. 

[Etaoin Shrdlu]

2 hours ago, JeffersLos said:

 

They will is the T&Cs have been breached. 

 

None of the T&Cs have time statutes. 

 

Section 865 of the Thai Civil and Commercial Code actually bars an insurer from voiding an insurance policy for non-disclosure after five years have elapsed from the time of inception of the contract.

 

"Section 865.

If at the time of making the contract, the assured, or, in case of insurance on life, the person upon whose life or death the payment of the sum payable depends, knowingly omits to disclose facts which would have induced the insurer to raise the premium or to refuse to enter into the contract, or knowingly makes false statements in regard to such facts, the contract is voidable.

 

If such right of avoidance is not exercised within one month from the time when the insurer has knowledge of the ground of avoidance, or within five years from the date of the contract, such right is extinguished."

 

I do not know how this plays out in practice, especially if the insurer were to allege fraud.

 

 

[Liverpool Lou]

13 hours ago, flyingtlger said:

health insurance companies are notorious for looking for any excuse to pay as little as possible....

What are you basing that on?

[Liverpool Lou]

10 hours ago, jerrymahoney said:

If I don't declare a pre-existing condition, how can the insurer found out when I put in a claim?

From you medical records that you agree to give them access to when you take a policy if their medical consultants don't immediately see the likelihood of your fraud when they examine your claim.

[noobexpat]

In the UK i know one very large company discloses its critical illness payouts. They express its as a % of their annual premium revenue. 

 

Pretty high, about 90% from memory.

[Liverpool Lou]

5 hours ago, CartagenaWarlock said:

Health insurance companies most likely won't refuse to pay customers with them for fifteen years. 

Health insurance companies most likely won't refuse to pay customers with them for fifteen years if their claims are legitimate and covered by the policy!   The length of time that they've been policyholders is irrelevant to the claim unless there's a specific exclusion for early claims.

[Liverpool Lou]

23 minutes ago, Etaoin Shrdlu said:

2 hours ago, JeffersLos said:

 

They will is the T&Cs have been breached. 

 

None of the T&Cs have time statutes. 

 

Section 865 of the Thai Civil and Commercial Code actually bars an insurer from voiding an insurance policy for non-disclosure after five years have elapsed from the time of inception of the contract.

 

"Section 865.

If at the time of making the contract, the assured, or, in case of insurance on life, the person upon whose life or death the payment of the sum payable depends, knowingly omits to disclose facts which would have induced the insurer to raise the premium or to refuse to enter into the contract, or knowingly makes false statements in regard to such facts, the contract is voidable.

 

If such right of avoidance is not exercised within one month from the time when the insurer has knowledge of the ground of avoidance, or within five years from the date of the contract, such right is extinguished."

There's a big difference between voiding an insurance contract and simply denying a claim on a valid contract because of non-disclosure of pre-existing conditions.

[Etaoin Shrdlu]

6 minutes ago, Liverpool Lou said:

There's a big difference between voiding an insurance contract and simply denying a claim on a valid contract because of non-disclosure of pre-existing conditions.

 

Yes, this is true. 

 

What the five-year limitation might best address is a situation in which the non-disclosure is not related to the claim in question, leaving recission of the contract the only means for the insurer to deny paying the claim.