Under What Circumstances Will An Insurance Company Not Pay Out On A Policy?
Why do you need health insurance in the first place
? Health insurance was created as a response to the high demands for a better health care service. Most people who regularly work in a big company are given the privilege of having their own health insurance provided that their company pays the specific amount every month to maintain the benefits.
If you are paying your health insurance on your own, you have to make sure to pay your monthly dues on time as this may be one of the reasons why your health insurance company would refuse to pay out on your policy.
There are numerous reasons that a health insurance company might not pay out on a claim, they need to be substantiated however to come to the conclusion that they do not need to pay you. Although these excuses may sometimes be true and duly supported by legal documents, some insurance companies will most likely find a small hole just to opt out their health insurance obligations. This is all the more reason why it is up to you to understand which insurance company you are going to sign with. Know who they are backed by and be sure you are confident to trust them.
Fraud is always a legal issue and if a person is caught lying about what they listed on their insurance forms it can have devastating effects when you expect a payout for any medical procedure. Legally if you lie, an insurance company is not liable to payout. If your health insurance company finds out that you have falsified documents just to avail their health insurance benefits, then you are in a really big trouble. A legal court may take action and file fraudulence against you. For serious cases that involve a lot of financial accountabilities, the punishment can be severe.
A health insurance company also has the right to refuse policy pay outs if the insured has been deceased within 2 years of the companys contestable period. Again, if fraud is discovered here within, regarding age, health and/or criminal records, the insurance company can decline any health coverage.
Another valid reason for a certain insurance company to refuse health insurances is if you fail to inform them of any medical conditions you have. Say, if you have a heart condition but intentionally did not indicate this upon your application for health insurance, the insurance company can refuse to pay your medical bills. To avoid this, remember to disclose all needed information upon acquiring your health insurance.
Health insurance companies can also deny benefits during its initial application. A good example is when you have a condition classified as an expensive medical condition, and then you try to apply for a policy. A person with cancer for example might be denied health insurance.
by: Eloise Kate
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