How complicated is the claims process for critical illness insurance? - Seedly
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Critical Illness (CI)

Insurance

Anonymous

Asked 3w ago

How complicated is the claims process for critical illness insurance?

I am currently deciding on a term CI policy between Prudential and Aviva. Prudential's is much more expensive, but my Prudential agent tells me that Prudential is better known than Aviva for having a smoother claims process, and that her guidance on how to ask the doctor for a diagnosis would be important should I ever make a claim. While I do think a smooth claim process is important for integrated shield plans, I'm not so sure about critical illness policies? Is this actually an issue?

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Hi anon,

The claim process is going to be quite standard regardless of the insurer.

Generally, you will have to submit a claims form and a doctor's statement, with supporting evidence such as relevant medical reports, scans, etc.

If the insurer requires additional information, they will get back to you. However, if the information provided is sufficient, then there is no reason to reject the claim.

I would like to understand what your agent meant by "better known than Aviva for having a smoother claims process". Is there a metric by which insurers are measured yearly for the 'smoothest' of their claims, and that Prudential is consistently ahead of Aviva (or any other insurer for that matter)? I have made claims and either they get paid out (due to being a valid claim) or get thrown out (due to not meeting one or more of the criteria). Claims should be assessed in black and white, and not subject to grey areas.

Also, that statement on "guidance on how to ask the doctor for a diagnosis" is a little ambiguous. What is meant by that statement? The doctor should diagnose based on medically available information and no one else other that another specialist or subject matter expert in the field should challenge the diagnosis. Unless your agent happens to have a M.D. as well, I think we should let the doctors do their job.

And for that matter, I'd like you think about this: what happens if you actually get blessed with good health and never claim (until you pass on)? Would you want to pay more in such a scenario?

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Question Poster

2w ago

Thanks for replying! I have cancelled the Prudential policy since I was in the freelook period. However, I am still a bit hesitant to go fkr Aviva as I heard they are to be bought by SingLife soon, which doesn't have the best credit rating. While I know there's the Policy Owner Protection Scheme where insurance companies, when bankrupt, will still be able to pay out at least 500k sum assured, I'm still a bit hesitant as I am getting insured for more. How important do you think credit rating is for an insurance company?
Elijah Lee
Elijah Lee

2d ago

Hi anon, I would say that most insurers shouldn't have an issue to payout their obligations. Credit rating does have a correlation on the ability of an insurer to pay the claims, however none of the credit ratings are, say, in the 'junk' category (which would really be a real problem). So I personally don't worry much about it if the insurer is at least rated investment grade and above.
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