Case Study

4. Claiming Difficulties

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Wendy has a client who is a cervical cancer patient. This type of cancer kills thousands of people in the world every year, with more than 570k new cases over the past year. 

 

She was worried when she was told that she had cancer. Having that said, having faith in modern medical technology, she knew that doctors could help her. She needed to have faith. 

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The first thing that doctors could do was to examine the cancer cells in her body. They conducted an in-vivo cell extraction, in a private hospital. When the medical report was out, she was devastated as the cancer cells were showing aggressiveness, which indicates a more severe type of cancer. Doctor’s advice was to conduct a medical surgery and remove the tissue. 

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The operation was a success. She could finally be a bit relieved. After the removal, a second cell extraction was conducted in a public hospital, and the result was dramatic. Medical report showed no aggressiveness from the cancer cells, which means the removal surgery was superfluous. She was stunned when she heard that. All the pain that she suffered, all the worrying from her family, all the medical expenses were induced by a medical error. She was furious as she felt like being tricked by all the medical staff in the hospital. 

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Another issue came, medical insurance coverage. At that time she was holding two critical illness insurance policies from AIA and M company respectively. When it comes to claiming the sum insured in a policy, both companies require aggressive cancer with medical proof. The issue is that she had got two conflicting medical reports, so which one would insurance companies rely on when she makes her claims? There is a hidden rule in the industry that companies would treat their old customers more leniently when it comes to claiming. She had been a customer of M company for over two decades, while she had purchased a critical illness policy from AIA for no more than a few years. Therefore, she went to M Company first. The thing did not turn out as she had expected. AIA granted the claim, while M Company rejected. 

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She called on M Company’s service agent and asked for an explanation. She was then told that M Company had relied on the second medical report which showed a negative result on the aggressiveness of the cancer cells thus rejected the claim. AIA, to the contrary, allowed the claim once there was a single medical report, whatever and whenever it had been made, which showed aggressiveness of cancer cells. 

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The corporate objective of AIA is to serve and to protect. Despite all the complexities in the terms and conditions of the insurance policy, AIA does not want to use them as a tool to reject claims. It is the trust and confidence from our customers that keep AIA thriving and achieving in this industry throughout all these years.