Things were going fantastic for 38-year-old Praveen Shukla
for a long time. With an enviable corporate career, great family and a
fantastic house at a prime location, he had it all. When someone suggested he
buy a health policy to safeguard any unforeseen medical mishap, the chain
smoker father of two, decide to skip what he termed ‘a minute detail.’ Two
years after buying a medical cover, when cancer struck, Shukla got another rude
shock. His insurance company denied him his claim stating that he had failed to
disclose that he was a smoker. Shukla had no choice but to sell off his house
and somehow managed to cover his medical costs. Today, after almost a full
recovery, he advises everyone that crucial details should not be skipped in
favour of getting a lower premium. Because then, the price that you pay
is very high.
In today’s world, whether you are a youngster at the
threshold of a career or a seasoned career professional, buying an insurancepolicy has become a need of the hour. Whether you opt for a health or life insurance policy if you decide to withhold facts or simply fudge them for a
bigger gain, there are high chances that your insurance company will get the better
of you. This is because insurance companies have their own ways of unearthing
the ‘truth’ of their policy holder if they get suspicious. Also, the principle
of “utmost good faith” comes into the picture, where both parties to the
insurance contract is obligated to disclose any material facts pertaining to
the policy. A failure to do so leaves the policy null and void, therefore the
insurance company can deny to pay in event of a claim.
These days, a lot of insurance companies are tying up with
detective agencies to uncover and ascertain facts about their policy holders.
For example, in Shukla’s case what probably let the cat out of the bag was the
fact that the medical reports submitted by him were vetted by a team of
medical-legal experts who probably raised some questions. Though his bloodstream
may have been clear, Shukla’s lung x-rays probably painted a different picture,
altogether. Many insurance companies employ such experts to sniff out if
anything is wrong.
Also, even if the policy holder has passed away, detectives
can be hired to authenticate his medical condition. These investigators collect
records or information from the medical stores/chemists within the vicinity of
the deceased’s residence, alongwith hospital records which may be corroborated
with information from relatives, neighbours or even the neighborhood
nursing home where the policy holder may have undergone treatment. Claims are
then settled or rejected after gathering all this information. Especially
in cases where the sum assured is a large amount.
Even if you fill your policy documents erroneously or
withhold information then you’re definitely giving your insurance company a
chance to smell a rat. So, it may be a good idea to look before you leap
because someone out there is definitely watching.
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