Life Ins Problem

[ericthai]

Hey Everyone.

Having a problem with a life ins company. My wife had a policy on her mom, dad and herself through siam commercial with New York Life, which I would expect to be a good company. However her mother died in July, never got an autopsy and I dont exactly what the cause was, she has been sick for about a year.

My wife had a policy on her mom for 3 yrs now. Now they are giving her the run around. First they said they are not going to pay because her mother had a preexisting condition, however they have been accepting the premiums for the last 3 years. We had the premiums paid up until August and her mother died in July. I have not spoken to the ins company as I had to come to the US for business. I told her if they are not going to honor the policy they should at least give the premiums back, but since they have been accepting the premiums then I know in the US that means they accepted the applicant and should pay. Worse case they should give up the premiums for this year.

Last I heard the agent keeps telling her two weeks, two weeks but now we are going in October. Does anyone know the laws on Ins in Thailand, is there a govt ministry that oversees the ins industry someone we can contact? Any help is much appreciated.

Thank you,

Eric

Edited September 29, 2009 by ericthai

[ThaivisaInsurance]

If you do not get satisfaction from either the insurance company or the Broker you bought from, then the next line of complaint is through the O.I.C. This is the Office of the Insurance Commission and they are the body who oversees insurance in Thailand.

T.V.Ins.

[chiangmaibruce]

Hi Eric

Hope you get it sorted out. They should pay unless you have failed to disclose a condition and were required to do so under the policy.

I don't know about the States but in Australia, the fact that an insurance company accepts your premium certainly doesn't obligate them to pay out anything. The insurance cover is a contract and both parties have rights and obligations under it. If you fail to meet your obligations then they can void the contract, e.g. failure to disclose all pertinant factors as spelt out in the fine print.

The alternative to this would see insurance premiums go through the roof as insurance companies would have to demand comprehensive check-ups for everyone before granting cover, plus having staff employed to locate and study your medical records, etc. Far easier and cheaper for them (and us) to just put the onus on the customer to disclose all relevant info and then do the investigating if and when a claim is subsequently ever made.

Edited September 30, 2009 by chiangmaibruce

[ericthai]

Thanks guys. I will work with her through the agent for another week and see what happens, then will check into the OIC.

As for teh pre-existing condition, the thing if she had a pre-existing condition we dont know what it was, as we were not aware of it. Her mother only started going to a doctor for aches and pains late last year which she would go see to the doctor maybe once a month or every 5-6 weeks something like that. The ins company asked for the doctors file and then at frist said they would not cove it. So we asked for our money back. If they are not going to pay they should re-turn the premiums paid, they cant have it both ways, if they had a doubt then they should have had her had a pre-exam. She was only 52 yrs old. She went to the hospital in the afternoon not feeling good, they gave her s shot she came home went to sleep and never got up. When my wife went to the hospital and asked them about the shot she was told to dont ask anymore questions. Sounds like they were doing some type of experimental medicine, who knows. THe money is niot much only 100,000 baht, but its the point that Im pissed off about.

Well, thanks for listenting to me vent.

Will do as you suggested TV ins.

[TerryLH]

"When my wife went to the hospital and asked them about the shot she was told to dont ask anymore questions."

I'd be more upset about that than the money.

[scorecard]

"When my wife went to the hospital and asked them about the shot she was told to dont ask anymore questions."

I'd be more upset about that than the money.

This industry in Thailand leaves a lot to be desired.

My family has had problems with:

- A life assurance policy

- A health insurance policy

- A condo contents policy

All three were with companies in joint ventures with major well known off-shore companies.

With The condo/contents policy I had to get very angry with the HO in the UK, then we got some action.

With the life assurance and the health insurance I had to go to their HO here in Bkk and refuse to leave until I saw their CEO. When I showed him a draft e-mail to be sent to the Government Insurance Commission, the CEO of the off-shore partner (in the US) and also draft e-mails to be sent to several local newspapers (English and Thai) and to several newspapers in the US, also the US insurance watchdog agency, they started to listen.

Waving my permanent resident book around also helped (not just because I have PR, but because they didn't understand what the book was and assumed that I was a diplomat or VIP or whatever).

Too much detail, but the staff at their HO were extremely rude to my Thai son and his wife, and I strongly demanded and got an apology.

I did in fact, after the event, send two e-mails to the world CEO in New York. Never received any reply.

On each occasion I mentioned the problems to the Thai agent who sold the policies. On every occasion the reply was "Never mind, I'm sure it will be OK next time". I also realised that the agent's broad knowledge of insurance was extremely limited and also realized that very specific questions were being answered with a guess that sounded nice.

- Two years back also had problems with a claim on a policy my office held in regard to cover for emergency hospital treatment whilst travelling on business.

My lesson:

Prepare a letter of understanding which covers the points they tried to use to not pay and demand the CEO signs the letter or go elsewhere.

Not my favorite industry.

[ericthai]

"When my wife went to the hospital and asked them about the shot she was told to dont ask anymore questions."

I'd be more upset about that than the money.

This industry in Thailand leaves a lot to be desired.

My family has had problems with:

- A life assurance policy

- A health insurance policy

- A condo contents policy

All three were with companies in joint ventures with major well known off-shore companies.

With The condo/contents policy I had to get very angry with the HO in the UK, then we got some action.

With the life assurance and the health insurance I had to go to their HO here in Bkk and refuse to leave until I saw their CEO. When I showed him a draft e-mail to be sent to the Government Insurance Commission, the CEO of the off-shore partner (in the US) and also draft e-mails to be sent to several local newspapers (English and Thai) and to several newspapers in the US, also the US insurance watchdog agency, they started to listen.

Waving my permanent resident book around also helped (not just because I have PR, but because they didn't understand what the book was and assumed that I was a diplomat or VIP or whatever).

Too much detail, but the staff at their HO were extremely rude to my Thai son and his wife, and I strongly demanded and got an apology.

I did in fact, after the event, send two e-mails to the world CEO in New York. Never received any reply.

On each occasion I mentioned the problems to the Thai agent who sold the policies. On every occasion the reply was "Never mind, I'm sure it will be OK next time". I also realised that the agent's broad knowledge of insurance was extremely limited and also realized that very specific questions were being answered with a guess that sounded nice.

- Two years back also had problems with a claim on a policy my office held in regard to cover for emergency hospital treatment whilst travelling on business.

My lesson:

Prepare a letter of understanding which covers the points they tried to use to not pay and demand the CEO signs the letter or go elsewhere.

Not my favorite industry.

Hey Sorcecard, I think Ins is not anyones favorite. Sorry you had problems. I'm in the US right now, trying to get things tied up here so I can get back and work on this with my wife. Sad thing is I'm expanding my company to open sales offices here in the USA and could not be there when this happened, then the run around and you know how Thai's are no the best at demanding things so she's not getting anywhere. I told her she needs to call the agent everyday. I hope to be back in the next 2 weeks and will step it up as you did. thats a good idea to go to the head office in BKK.

thanks for the advise.

Eric

[pakorn8000]

File a complaint to OIC.or.th.

ฺBy law, if the insurance company does not find out about the preexisting condition within 2 years since the policy issued. The policy is 100% binding.

[jazzbo]

By law, if the insurance company does not find out about the preexisting condition within 2 years since the policy issued. The policy is 100% binding.

As has been covered elsewhere in this Forum ad nauseam, the above only applies if the preexisting condition was truly unknown to the insured; NOT if it was fraudulently withheld on the insurance application.

[pakorn8000]

Nope. It works even the insured does a fraud, too. I don't like to see it this way as well, but this is true. If the insurance company could not find out within 2 years. The policy is legally binding.

The law seems to be in favor of the consumer more than the insurance company.

Edited November 9, 2009 by pakorn8000

[jazzbo]

Almost all if not all health insurance application forms have some variance of the Thailand Civil and Commercial Code Section 865 notice e.g.:

"Before you enter into this policy, you must provide to the Insurance Company with the information, needed to enable the Insurance Company to decide whether and on what terms your proposal for insurance is acceptable and to calculate how much premium is required for your insurance. In the event that you

fraudulently misrepresent, or conceal information,

the Insurance Company reserves the right to increase the premium, or reject the claim and void the policy in accordance with clause 865 of the Civil & Commercial Code."

The Statute of Limitations clause in the same Civil and Commercial Code is (courtesy of Samui4Sale):

*Section 448*. The claim for damages arising from wrongful act is barred by prescription after one year from the day when the wrongful act and the person bound to make compensation became known to the injured person,

or ten years from the day when the wrongful act was committed.

[jazzbo]

from the screenplay of The Flight of the Phoenix (1965 version) with James Stewart:

Standish: Insurance companies move in mysterious ways. Much like God... only far less generous.

[pakorn8000]

Almost all if not all health insurance application forms have some variance of the Thailand Civil and Commercial Code Section 865 notice e.g.:

"Before you enter into this policy, you must provide to the Insurance Company with the information, needed to enable the Insurance Company to decide whether and on what terms your proposal for insurance is acceptable and to calculate how much premium is required for your insurance. In the event that you fraudulently misrepresent, or conceal information, the Insurance Company reserves the right to increase the premium, or reject the claim and void the policy in accordance with clause 865 of the Civil & Commercial Code."

The Statute of Limitations clause in the same Civil and Commercial Code is (courtesy of Samui4Sale):

*Section 448*. The claim for damages arising from wrongful act is barred by prescription after one year from the day when the wrongful act and the person bound to make compensation became known to the injured person, or ten years from the day when the wrongful act was committed.

Try "life insurance law" instead.

[jazzbo]

There is no such thing in Thailand as Life Insurance Law. There is the Thailand Life Insurance Act of 1992 but it pertains to the regulation of Life Insurers and Brokers; not fraud which comes under the Thai Civil and Commercial Code as I referenced. The Life Insurance Act has only one section (Section 36) that deals with claims and is purely of an administrative nature.

In my experience with Insurance companies they are far more likely to say that their particular needs would warrant a statute of Limitations that would exceed that normally granted; not voluntarily surrender to less. Why would they agree to 2 year limitation when everyone else is granted 10 year Statute of Limitations? ...and they very specifically spell out via the Section 865 fraud reference that any falsification, misrepresentation, or withholding of information on the application they will consider as fraud...

... but if you want to hold your breath for 2 years, please go right ahead.