VHI Claim refusal during waiting period

Discussion in 'Health Insurance and healthcare costs' started by Mac888, Feb 14, 2017.

  1. Mac888

    Mac888 New Member

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    Is there any organisation that can help with a claim refusal based on 'deemed' pre-existing medical condition whilst serving the waiting period?
     
  2. snowyb

    snowyb Frequent Poster

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  3. cremeegg

    cremeegg Frequent Poster

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    Who has deemed the condition to be pre-existing ?

    The facts on this are usually grey and it is a matter of medical assessment if a condition is pre-existing.

    Ask your consultant to write to the health insurer confirming that the condition was newly arising.
     
  4. Mac888

    Mac888 New Member

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    Thanks Snowyb, I will contact the HIA as per your suggestion.
     
  5. Mac888

    Mac888 New Member

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    Thanks Cremegg, VHI have deemed pre-existing even though consultant has confirmed it's new. Seems they can "deem" something to be present even if it's not, I can't find anything in their T & C that explains their standpoint. Very disappointed with VHI.
     
  6. michaelm

    michaelm Frequent Poster

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    Have you not had health insurance previously (with VHI or others)? VHI refused a claim I had a few years ago, after I'd just moved to them, but when I gave them details of my previous 5 years insurance with other providers they paid up.
     
    Ravima likes this.
  7. peteb

    peteb Frequent Poster

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    Completely different. There isnt waiting periods if you previously held cover.
     
  8. michaelm

    michaelm Frequent Poster

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    Yes, but my point is that VHI didn't have (and never sought) my previous details and refused payment. I'm sure that happens often. Some who would be covered may not realise that it's a paperwork issue that they can remedy.
     
  9. Mac888

    Mac888 New Member

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    No previous insurance and the waiting period applies except for "new" conditions, insurance company just refuses to recognise it's new. Actually it's not even a condition as procedure was exploratory test which came back clear and no treatment was required. If I'd known how dishonest they are I'd never have joined. Would be useful to know if there are many others who have been refused like me?
     
  10. twofor1

    twofor1 Frequent Poster

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    I was involved in a case a few years ago against the VHI, for different reasons to yours they refused to pay for an expensive cardiac procedure for a family member.

    They went to great lengths explaining in detail why our claim could not be paid.

    A complaint was then made to the FSO who accepted and wrote to the VHI asking a a number of questions.

    That was as far as it went, the VHI phoned us and followed it up in writing saying they had reconsidered and were now willing to pay the €40K+ claim in full if we withdrew our complaint.

    It seems to me that VHI like banks, might routinely reject all complaints, even one’s they know would be successful, knowing that the majority will not take that final step in the complaints procedure.

    If you think you have a case, get your final response from the VHI, fill in the simple FSO complaint form and see what happens.
     
  11. Mac888

    Mac888 New Member

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    Thank you twofor1, I'll give that a go, glad your case was resolved.
     
  12. Ravima

    Ravima Frequent Poster

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    No previous insurance and the waiting period applies except for "new" conditions, insurance company just refuses to recognise it's new. Actually it's not even a condition as procedure was exploratory test which came back clear and no treatment was required. If I'd known how dishonest they are I'd never have joined. Would be useful to know if there are many others who have been refused like me?

    Just being devils advocate here - why was the exploratory test required and how long were the symptoms being complained of BEFORE policy was taken out?
     
  13. DirectDevil

    DirectDevil Frequent Poster

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    I have had a bit of a problem with this issue too.

    See this link to the Health Insurance Authority page about waiting periods for new customers
    http://www.hia.ie/consumer-information/waiting-periods/new-customer-waiting-periods

    Also, from the same site "From 1 May 2015 a pre-existing condition is defined as:

    "Pre-existing condition” means an ailment, illness or condition, where, on the basis of medical advice, the signs or symptoms of that ailment, illness or condition existed at any time in the period of 6 months ending on the day on which the person became insured under the contract."


    My read of the situation is that insurers have rendered determination of the issue as now being objective as distinct from subjective. In other words, if the insurer's doctor says that the condition must have existed clinically - even though you may not have been aware of it symptomatically - their view prevails.

    What can certainly be challenged is the VHI's assertion if their doctor's view conflicts with your consultant's view of the issue. It seems like VHI may have formed a presumptive and premature opinion without full possession of all of the evidence. Get your consultant's written confirmation of the facts and send that to VHI with a request to reconsider their position on the basis that their view was formed without adequate consideration of all relevant evidence.
     
  14. AlbacoreA

    AlbacoreA Frequent Poster

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    It seems like a catch all so they can refuse all claims by default.
     
  15. Mac888

    Mac888 New Member

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    Thanks for your opinion, I have done this and am awaiting their reply.