Experience with insurances company using underwriting to push back policy

juay0004

New Member
Hi all,

Wish to hear from others if they have been in a similar situation.

I recently had a bad experience with my wife insurance agent for her maternity insurance.
we started look at insurance policy around 16weeks and my wife decided to put pen to the paper with an insurance policy with GE last Wednesday when she was 19th weeks.
We make know to the agent that we were hoping to locked it away before our detailed scan which is the purpose of an maternity insurance.
For those unaware, GE maternity insurance starts from week 13 as advertised from their brochure.

Today, we got a document from GE underwriting department stating that we need to submit our first trimester report and our 20th week detailed scan for them(which we will only take in 2 days time) to evaluate before they can decide if they want to honour the policy my wife pen last Wednesday. No reason was given as what guidelines or medical condition warrant this delay.
We had an previous abortion due to Edward syndrome last year that we declared in the contract.

I had a call with the agent and he claims that for certain cases, if the application is too close to 20th week, the underwriter can delay the application will they receive the report. I feel that this is an unfair practise if what he said is true as this allow the company to get past a set of claims if there is complications that is claimable during that test by pushing/delaying the claims.

He also said that the documents could be required due to our declaration. Also, i think this is unfair as Edward syndrome is not covered but to be fair(cleft lip- a symptom of Edward syndrome is covered). It will be fair if they proceed with an exclusion to cleft lip rather than push us back to the detailed scan report date and if anything do happen, we are on our own.

My research on Edward syndrome states that most of the cases are random and rarely due to inheritance. So chances are, medically, we should not be under a exclusion. If they reckon there is a risk, they should exclude that condition stating if this is inherited, they will not pay out.

As a company, they are playing on my timeline which now stands 2 days before my detail scan sucks as any other insurance company won't be able to take my policy in time.

My idea of insurance is that a group of people paying each a sum of money, pooled together to manage medical conditions/death unless they are medically excluded as it tilts the balance of premium for other policy holders.
In this arrangement, the fund manager will earn a middle man money or by investing those money elsewhere which I reckon it fair.
Why does my wife and my baby have to be subjected to a delay in coverage even though medical statistics states that this previous occurrence is random? We are buying in at a period stated in their brochure trying to cover our baby with what they advertised to protect against yet we are pushed back.

The guidelines they follow are not stated. No reason given. Are we so called parents to be penalised unnecessarily?
 
Hi all,

Wish to hear from others if they have been in a similar situation.

I recently had a bad experience with my wife insurance agent for her maternity insurance.
we started look at insurance policy around 16weeks and my wife decided to put pen to the paper with an insurance policy with GE last Wednesday when she was 19th weeks.
We make know to the agent that we were hoping to locked it away before our detailed scan which is the purpose of an maternity insurance.
For those unaware, GE maternity insurance starts from week 13 as advertised from their brochure.

Today, we got a document from GE underwriting department stating that we need to submit our first trimester report and our 20th week detailed scan for them(which we will only take in 2 days time) to evaluate before they can decide if they want to honour the policy my wife pen last Wednesday. No reason was given as what guidelines or medical condition warrant this delay.
We had an previous abortion due to Edward syndrome last year that we declared in the contract.

I had a call with the agent and he claims that for certain cases, if the application is too close to 20th week, the underwriter can delay the application will they receive the report. I feel that this is an unfair practise if what he said is true as this allow the company to get past a set of claims if there is complications that is claimable during that test by pushing/delaying the claims.

He also said that the documents could be required due to our declaration. Also, i think this is unfair as Edward syndrome is not covered but to be fair(cleft lip- a symptom of Edward syndrome is covered). It will be fair if they proceed with an exclusion to cleft lip rather than push us back to the detailed scan report date and if anything do happen, we are on our own.

My research on Edward syndrome states that most of the cases are random and rarely due to inheritance. So chances are, medically, we should not be under a exclusion. If they reckon there is a risk, they should exclude that condition stating if this is inherited, they will not pay out.

As a company, they are playing on my timeline which now stands 2 days before my detail scan sucks as any other insurance company won't be able to take my policy in time.

My idea of insurance is that a group of people paying each a sum of money, pooled together to manage medical conditions/death unless they are medically excluded as it tilts the balance of premium for other policy holders.
In this arrangement, the fund manager will earn a middle man money or by investing those money elsewhere which I reckon it fair.
Why does my wife and my baby have to be subjected to a delay in coverage even though medical statistics states that this previous occurrence is random? We are buying in at a period stated in their brochure trying to cover our baby with what they advertised to protect against yet we are pushed back.

The guidelines they follow are not stated. No reason given. Are we so called parents to be penalised unnecessarily?


From what i know, underwriting is a standard process in the insurance company before they accept and issue any policy.
If i m not wrong, when insurance company advertise that they can start to insure you from week 13, it simply means that the pregnant mother can start applying for coverage from 13th weeks onwards. But it does not mean that the insurance company must accept the application unconditionally.
They have one whole list of guidelines on what kind of cases they can accept without asking questions (usually straightforward and simple one) and which kind of cases they have to investigate.
Like what you have rightly put, insurance is pooling of risk. Hence everyone who are in the same pool should have similar risk and equal chance to claim.
You mentioned that your wife’s previous pregnancy was abnormal due to Edward syndrome. That means your wife is probably at higher risk as compared to others. I think it is right for insurer to be prudent in risk selection so to be fair to other people who are buying the same policy. They have the right to ask for relevant documents to make decision.
Maybe your agent can explain that to you if you have query.
 
From what i know, underwriting is a standard process in the insurance company before they accept and issue any policy.
If i m not wrong, when insurance company advertise that they can start to insure you from week 13, it simply means that the pregnant mother can start applying for coverage from 13th weeks onwards. But it does not mean that the insurance company must accept the application unconditionally.
They have one whole list of guidelines on what kind of cases they can accept without asking questions (usually straightforward and simple one) and which kind of cases they have to investigate.
Like what you have rightly put, insurance is pooling of risk. Hence everyone who are in the same pool should have similar risk and equal chance to claim.
You mentioned that your wife’s previous pregnancy was abnormal due to Edward syndrome. That means your wife is probably at higher risk as compared to others. I think it is right for insurer to be prudent in risk selection so to be fair to other people who are buying the same policy. They have the right to ask for relevant documents to make decision.
Maybe your agent can explain that to you if you have query.

Hi Lynn,

Thank you for your input.

I understood that underwriting is a standard process of any policy.
I know of a few friends who have exclusions due to high BP etc and so I have been aware for quite a while.

I am not asking the company to accept me unconditionally.
I understand that they may have guidelines and if they give an exclusion, it is better than no coverage going into a 20th week scan.

But I have to say that you are likely misinformed that my wife is higher risk compared to others by only knowing that we had an abortion due to Edward syndrome.
My wife previous gynaecologist cleared us and did not ask for any further test after my wife had the abortion.
My own search on the web all turn up saying that this a very unfortunate process that is random due to how the egg interact/join with the sperm.
Statistics are that 1 in every 3000 to 6000 live pregnancy has Edward syndrome, and the factor that seem to have some weight in bringing the risk up is age which my wife is 31 years old.
My current gynaecologist also stated to me that the insurance company has no medical ground to doubt that we are in a higher risk.

I have no issue with them asking for the first trimester report.
To wait for the 20th week report, which eliminates a lot of the risk for them is a big company playing with the clauses to their advantage.

My basis is that, why is a random event in the past taken as a condition for underwriting when it has no medical grounds?
I see it on the same basis that, a person who was previously knocked down at a traffic junction while waiting for a green man is has his policy push back because he is standing waiting for the green man again.
Did he inherit some diseases that make him a magnet for a car that veer off the road to knock him down? no.
The company refuse to give him a effective policy when he is now currently having the same risk as any other person waiting for a green man without any strong/concrete reason.

I asked for a sample for their guidelines but got nothing in return.
So is the underwriter following something? medically knowledgeable to assess? got the right support to make decisions?
Unfortunately, I won't know.
Not when people think it is fine for the insurance company to categories my wife as high risk without basis.

To me, it is like profiteering. Take the premiums after the a large part of the risks are downplayed after the detail scan.
 

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