WRLife

[Hummin]

3 minutes ago, bkk6060 said:

I would be more concerned about the fraud by fellow expats then these insurance companies.

I have had conversations with representatives of some of these companies including WR Life.

People getting a plan and opting for the monthly payment option.  Then, a few months later making claims for long type of illnesses that they probably knew about prior to their application.  They suddenly get diabetes, cancer, heart disease..

Many of these claims are rejected with the suspicion of fraud, as they should be. 

So, stop the lies and making things more difficult for the legit people who want insurance if they infact have a future illness.  

I had once a heads up from my dr I had high sugar in my blood, but truth is, I was healthy, working out regulary, and most likely had a big fat meal the day before my bloodtests, and therefor my cholestrol was a bit in the high end to. 

 

Everyone who push 50 or more, is likely to have any underlying condition, that can show up on one or two bloodtests before everything normalize again. 

 

 

[scubascuba3]

4 hours ago, QuantumQuandry said:

 

Interesting how you skipped the next 5 reviews that were all 5 stars...

i posted just the two recent but i tend to take 5* reviews with a pinch of salt, same Lazada, some fake, some where people have paid premiums quickly and rate 5*. 1 to 4* tend to be much more useful

[scubascuba3]

4 hours ago, bkk6060 said:

I would be more concerned about the fraud by fellow expats then these insurance companies.

I have had conversations with representatives of some of these companies including WR Life.

People getting a plan and opting for the monthly payment option.  Then, a few months later making claims for long type of illnesses that they probably knew about prior to their application.  They suddenly get diabetes, cancer, heart disease..

Many of these claims are rejected with the suspicion of fraud, as they should be. 

So, stop the lies and making things more difficult for the legit people who want insurance if they infact have a future illness.  

but i recall threads on wrlife where they were accepting people with pre existing conditions, maybe a 6 month period first, you can't then reject claims

[NanLaew]

18 hours ago, KannikaP said:

They will possibly try to find something from the patient's dim and distant past.

 

You mean like Pacific Cross did with me? A solitary instance of Stage 1 hypertension (that's non-persistent) from 8 years ago was enough for them to add a 10% weighting to my annual premium.

Edited June 9 by NanLaew

[QuantumQuandry]

8 hours ago, scubascuba3 said:

i posted just the two recent but i tend to take 5* reviews with a pinch of salt, same Lazada, some fake, some where people have paid premiums quickly and rate 5*. 1 to 4* tend to be much more useful

 

With Lazada, I might agree (though I tend to ignore the 1* as well as the 5* there).  But in this case, if I was to leave a review after making a claim, it would likely be either:

1* - they didn't pay my claim or 5* - they paid my claim.

 

Looking at the bigger insurance companies, their ratings seem to follow that pattern, as well, with the vast majority being at either 1* or 5*.

 

 

[scubascuba3]

2 hours ago, NanLaew said:

 

You mean like Pacific Cross did with me? A solitary instance of Stage 1 hypertension (that's non-persistent) from 8 years ago was enough for them to add a 10% weighting to my annual premium.

how did they find out?

[NanLaew]

4 hours ago, scubascuba3 said:

how did they find out?

 

In order to process a claim for emergency surgery, they requested my medical history. My only medical history in Thailand are my biennial offshore medicals, so I agreed for them to be shared by Bumrungrad who did the medicals. Some three months after my claim was paid, and based on the single instance of stage 1 hypertension, they asserted that I hadn't made a full disclosure. They gave me the option to pay the excess or completely cancel with a partial refund of the premium. Also note that the claim was for a procedure that had absolutely nothing to do with any sort of hypertension.

[scubascuba3]

44 minutes ago, NanLaew said:

 

In order to process a claim for emergency surgery, they requested my medical history. My only medical history in Thailand are my biennial offshore medicals, so I agreed for them to be shared by Bumrungrad who did the medicals. Some three months after my claim was paid, and based on the single instance of stage 1 hypertension, they asserted that I hadn't made a full disclosure. They gave me the option to pay the excess or completely cancel with a partial refund of the premium. Also note that the claim was for a procedure that had absolutely nothing to do with any sort of hypertension.

a familiar story, a lawyer friend was telling me of a similar case with a different health insurance company, they must love that, look for the undisclosed pre existing conditions when a claim is made

[newbee2022]

2 hours ago, scubascuba3 said:

a familiar story, a lawyer friend was telling me of a similar case with a different health insurance company, they must love that, look for the undisclosed pre existing conditions when a claim is made

Well, if you hide health issues they're free. No payment, no contract anymore. Nada.

[CharlieH]

Off topic posts removed.

[Etaoin Shrdlu]

An applicant for insurance has a duty to disclose all material facts that would affect an insurer's decision to accept the applicant's risk, what terms and conditions to offer, and what premium to charge. This duty of disclosure isn't limited to what the applicant can remember or is aware of at the time of application.

 

Many insurers will bow to convenience and accept whatever an applicant puts on the proposal form rather than requiring a detailed medical history from the applicant's medical providers. Then, when a large claim is presented, they conduct the type of underwriting exercise that should have been done at the proposal stage solely for the purpose of denying the claim.

 

Most of us can't remember every detail contained in our medical records going back many years and indeed not all details may have been discussed with the medical professional at the time. We may also not always understand the full implications of our test results or other information contained in our records. This can easily lead to unintentional non-disclosure that may later jeopardize coverage.

 

I would suggest that all applicants not only complete the proposal form, but also obtain and submit their medical records going back as far as possible at the time of application. This may be less convenient initially, but will probably significantly reduce the possibility that an insurer would decline a claim due to non-disclosure. With digitized medical records, this isn't difficult or time-consuming to do. Ask your insurance broker for their recommendations on how to avoid post-claim underwriting as well.

 

 

[simon43]

[quote]

Also note that the claim was for a procedure that had absolutely nothing to do with any sort of hypertension.

[/quote]

 

This is exactly the same reason why my claim was refused by April International (France).  I had (unwittingly) failed to disclose a minor medical condition that was unrelated to my claim.  My claim was refused and my insurance cancelled without any refund.

 

As mentioned in another thread, this is why when I applied to WR Life for insurance, I sent them 2 pages of my medical history from the age of 10(!).  This included falling off a fence, a bunion, a scar on my leg from a motorbike accident etc. This seemingly-crazy statement was to ensure that WR Life were fully aware of my full medical history, and would be unable to dispute a valid claim.  They gave me full cover, only excluding the medical condition that I had previously claimed for with April.

 

The short of it all - if you fail to disclose ANY pre-existing or medical condition or procedure or accident, whether it is related to your claim is immaterial - it is a reason to deny your claim. 

[jerrymahoney]

3 hours ago, Etaoin Shrdlu said:

Most of us can't remember every detail contained in our medical records going back many years and indeed not all details may have been discussed with the medical professional at the time.

Having a 20 year claims history -- or no claims history -- with a Thai insurer helps when switching to a new cover.

[Etaoin Shrdlu]

1 hour ago, jerrymahoney said:

Having a 20 year claims history -- or no claims history -- with a Thai insurer helps when switching to a new cover.

 

Yes, if the underlying medical history can be supplied to the new insurer when applying for cover. Coverage with a previous insurer does not equate to disclosure to a new insurer. Still need to be careful.

[Etaoin Shrdlu]

3 hours ago, simon43 said:

[quote]

Also note that the claim was for a procedure that had absolutely nothing to do with any sort of hypertension.

[/quote]

 

This is exactly the same reason why my claim was refused by April International (France).  I had (unwittingly) failed to disclose a minor medical condition that was unrelated to my claim.  My claim was refused and my insurance cancelled without any refund.

 

As mentioned in another thread, this is why when I applied to WR Life for insurance, I sent them 2 pages of my medical history from the age of 10(!).  This included falling off a fence, a bunion, a scar on my leg from a motorbike accident etc. This seemingly-crazy statement was to ensure that WR Life were fully aware of my full medical history, and would be unable to dispute a valid claim.  They gave me full cover, only excluding the medical condition that I had previously claimed for with April.

 

The short of it all - if you fail to disclose ANY pre-existing or medical condition or procedure or accident, whether it is related to your claim is immaterial - it is a reason to deny your claim. 

 

Yes, the issue  isn't whether the undisclosed condition is relevant to the claim, it is whether the undisclosed condition is relevant to the insurer's underwriting decisions regarding acceptance, terms and conditions, and premium.

 

In some more mature insurance markets, an insurer may have to prove to the regulator that if the condition were disclosed the insurer would have declined to issue a policy or would have excluded the condition that was the subject to the claim, or that the non-disclosure was intentional. Failing this, and depending upon the regulations in place, the insurer may be forced to pay the claim, although perhaps subject to an additional premium or higher deductible that might have been applied had the condition been disclosed. This is one of the reasons why the regulatory jurisdiction of an insurance policy should be of interest to a policyholder.

[jerrymahoney]

Life

16 minutes ago, Etaoin Shrdlu said:

 

Yes, if the underlying medical history can be supplied to the new insurer when applying for cover. Coverage with a previous insurer does not equate to disclosure to a new insurer. Still need to be careful.

I'm not sure what there is to be careful about. At least from WrLife application form:

 

DID YOU HAVE A PREVIOUS COVER (NOT TRAVEL COVER)
IF YES, PLEASE SEND US THE INSURANCE CERTIFICATE:

 

 

 

[Etaoin Shrdlu]

1 minute ago, jerrymahoney said:

Life

I'm not sure what there is to be careful about. At least from WrLife application form:

 

DID YOU HAVE A PREVIOUS COVER (NOT TRAVEL COVER)
IF YES, PLEASE SEND US THE INSURANCE CERTIFICATE:

 

 

 

 

Completing the application form and providing a certificate of cover from a previous insurer does not necessarily mean that the proposer has fulfilled his or her duty of disclosure to the new insurer.  The duty of disclosure goes beyond providing what the insurer requests on the proposal form. Many Thai insurers refer on their proposal for to the section of the Thai Civil and Commercial Code that establishes the proposer's duty to disclose. The Thai Civil and Commercial Code does not limit the proposer's duty of disclosure to the questions asked or documents requested on the proposal form. This isn't unique to Thailand, but I don't know what the regulations or laws are on Nevis.

[jerrymahoney]

3 minutes ago, Etaoin Shrdlu said:

 

Completing the application form and providing a certificate of cover from a previous insurer does not necessarily mean that the proposer has fulfilled his or her duty of disclosure to the new insurer.  The duty of disclosure goes beyond providing what the insurer requests on the proposal form. Many Thai insurers refer on their proposal for to the section of the Thai Civil and Commercial Code that establishes the proposer's duty to disclose. The Thai Civil and Commercial Code does not limit the proposer's duty of disclosure to the questions asked or documents requested on the proposal form. This isn't unique to Thailand, but I don't know what the regulations or laws are on Nevis.

They also ask on the application:

 

MEDICAL PREEXISTING CONDITIONS (IF ANY):

 

past or present sickness, past surgery, medicine taken

 

Edited June 11 by jerrymahoney

[Etaoin Shrdlu]

18 minutes ago, jerrymahoney said:

They also ask on the application:

 

MEDICAL PREEXISTING CONDITIONS (IF ANY):

 

past or present sickness, past surgery, medicine taken

 

 

A problem can arise when the applicant doesn't remember or is not aware of all previous medical issues reflected in his or her medical records. At least one poster in this thread was denied a claim because he was not aware of or did not understand the implications of something in his medical records that was later unearthed when he presented a claim. The duty of disclosure goes far beyond the level at which an insurer will issue a policy.

[Sheryl]

5 hours ago, Etaoin Shrdlu said:

Many insurers will bow to convenience and accept whatever an applicant puts on the proposal form rather than requiring a detailed medical history from the applicant's medical providers. Then, when a large claim is presented, they conduct the type of underwriting exercise that should have been done at the proposal stage solely for the purpose of denying the claim.

 

 

Exactly what most, if not all, Thai insurers do.

 

it is a clear warning sign if the enrollment form does nto contain a detailed medical history that is coherent (I have seen ridiculous forms asking people to check yes or no to have ever had a cough/sore throat, for example).

 

People sometimes think no medical questionnaire is a good thing. It is not. It means that they will wait until there is a claim to decide what conditions they consider pre-existing.

[jerrymahoney]

16 minutes ago, Etaoin Shrdlu said:

 

A problem can arise when the applicant doesn't remember or is not aware of all previous medical issues reflected in his or her medical records. At least one poster in this thread was denied a claim because he was not aware of or did not understand the implications of something in his medical records that was later unearthed when he presented a claim. The duty of disclosure goes far beyond the level at which an insurer will issue a policy.

And sometimes people don't spend sufficient time reading the application.

[2ndhomepattaya]

On 6/8/2024 at 10:07 PM, bkk6060 said:

Many of these claims are rejected with the suspicion of fraud, as they should be. 

So, stop the lies and making things more difficult for the legit people who want insurance if they infact have a future illness.  

I am sure very often it is not fraud simply the patient, not medically trained does not know.

In my case, on a Monday morning at work, my boss had reports from my work colleagues that I was roaming the kitchen apparently in a confused state. So, he took me home and told me to take a week off and see a doctor.

So, off I went in the afternoon the same day to see a GP. He just did his usual things and the usual questions on meds I took like blood pressure and so on,  all of which he had a record anyway of. exclaiming that there was nothing wrong with me. But, he said, I can tell you it's not a stroke.

If you are still concerned go to the local hospital. So, like a good boy, off I went at 6 AM next morning to the district hospital. Guess what, 4 hours late they sent me home, as they could not find anything either.

Terrific, it appears there  is absolutely nothing wrong with me.

Now it was only Tuesday so I decided to enjoy my few days, gifted days, off.

Come Friday, my mate came for breakfast and halfway through when I apparently started taking jibberish.

The ambulance came and they immediately diagnosed a stroke affecting the left side artery. within 24 hours I was on the operating table at Oxford University Hospital with a 75% blockage.

Happily for me, 7 years later I fully recovered, mind no thanks to the GP nor the first hospital.

Now, are you suggesting as per above that I should have known???

Prior to this I had not even been near a hospital in 50 years.

[scubascuba3]

40 minutes ago, 2ndhomepattaya said:

I am sure very often it is not fraud simply the patient, not medically trained does not know.

In my case, on a Monday morning at work, my boss had reports from my work colleagues that I was roaming the kitchen apparently in a confused state. So, he took me home and told me to take a week off and see a doctor.

So, off I went in the afternoon the same day to see a GP. He just did his usual things and the usual questions on meds I took like blood pressure and so on,  all of which he had a record anyway of. exclaiming that there was nothing wrong with me. But, he said, I can tell you it's not a stroke.

If you are still concerned go to the local hospital. So, like a good boy, off I went at 6 AM next morning to the district hospital. Guess what, 4 hours late they sent me home, as they could not find anything either.

Terrific, it appears there  is absolutely nothing wrong with me.

Now it was only Tuesday so I decided to enjoy my few days, gifted days, off.

Come Friday, my mate came for breakfast and halfway through when I apparently started taking jibberish.

The ambulance came and they immediately diagnosed a stroke affecting the left side artery. within 24 hours I was on the operating table at Oxford University Hospital with a 75% blockage.

Happily for me, 7 years later I fully recovered, mind no thanks to the GP nor the first hospital.

Now, are you suggesting as per above that I should have known???

Prior to this I had not even been near a hospital in 50 years.

Maybe you were overweight, smoker, who knows, no details given, insurer must base things on various info

[2ndhomepattaya]

3 hours ago, scubascuba3 said:

Maybe you were overweight, smoker, who knows, no details given, insurer must base things on various info

May I suggest that they make it up as it suits them? Before this all happened I had a medical at the BHP and an all-clear. Not smoked for 30 years, BMI of 25 so nothing untoward.  Elevated BP admittedly but sugar reading of below 100. It came back as anything with HP and diabetes exclused...even my doc found this highly incomprehensible. Needless to say, this insurer was off my list permanently.

[atpeace]

49 minutes ago, 2ndhomepattaya said:

May I suggest that they make it up as it suits them? Before this all happened I had a medical at the BHP and an all-clear. Not smoked for 30 years, BMI of 25 so nothing untoward.  Elevated BP admittedly but sugar reading of below 100. It came back as anything with HP and diabetes exclused...even my doc found this highly incomprehensible. Needless to say, this insurer was off my list permanently.

Why the medical? 

 

[topt]

30 minutes ago, atpeace said:

Why the medical? 

 

I know some people who have a medical every year or 2 to see what has changed if anything. The poster you asked may have another reason of course.

 

I was also taught prevention is better than cure...........

[atpeace]

11 minutes ago, topt said:

I know some people who have a medical every year or 2 to see what has changed if anything. The poster you asked may have another reason of course.

 

I was also taught prevention is better than cure...........

True but he stated previously he hasn't been near a hospital in 50 years. Probably just a mistake.  His story is missing so many details.

[CharlieH]

This has run its course.

 

CLOSED