by Guest » Tue Apr 29, 2008 04:41 am
Hi,
I'm from Cali..just needed a couple of information before I opt for a family coverage.
I've come across certain terms, would like you guys to clarify!
..if I may ask..what sort claims could be classified as Suspected Fraudulent claims? How are these claims classified? I think the claims process should be vivid & smooth, since if I don't get what I'm paying for then I'd better think twice..
be right bk, JoyceT
I'm from Cali..just needed a couple of information before I opt for a family coverage.
I've come across certain terms, would like you guys to clarify!
..if I may ask..what sort claims could be classified as Suspected Fraudulent claims? How are these claims classified? I think the claims process should be vivid & smooth, since if I don't get what I'm paying for then I'd better think twice..
be right bk, JoyceT
Posted: Tue Apr 29, 2008 05:42 am Post Subject:
Hi, yes its true that there are some claims which have been termed as suspected fraudulent claims. Claims investigations if reveal any of the following, then they would be named as fraudulent claims:
(i) Any exaggerated financial loss (ii) A distorted history of an event (iii) Organized accident
Primarily these are the ones for health care, there could be many more!
MegSezz
Posted: Tue Apr 29, 2008 07:20 am Post Subject:
Hey there!
I've perceived one thing specifically for these healthcare co.s is that they would often direct their marketing attempts towards preying the senior citizens. Reps would often upsell forcibly, misrepresent, or sell useless products to them. It is not always possible for the insurers to look after the services rendered by their agents or test the quality that is being enjoyed by the policy holders. The agents would often have the chance to manipulate transactions against the interest of both the policy holders & the carriers. So, it is better to have someone in control (preferably younger) who'd care for your interests!
Thanks,
Plasticmind
Posted: Tue Apr 29, 2008 09:15 am Post Subject:
How are these claims classified?
Claims would be as per that specific branch of insurance that it concerns. But yeah, regarding the justification of terming those claims as 'frauds', we do consider some of the things to make sure if that has actually risen enough reason for our suspicion.
A close review of our witnesses, photos, associated docs, testimony etc. could form vital evidence towards such a decision. Hope you'd take all of these things into consideration before you brand a claim as a fraudulent claim. But my friend, lemme tell one more thing, it is not about counting one or two of these factors that way, rather it is about testing a combination of one or more of them.
So, I don't think there is reason enough to get scared so much to lose an opportunity of getting covered for such a vital issue as health.
Regards,
Crossbreed07
Posted: Tue Apr 29, 2008 10:42 am Post Subject:
Good morning Joyce and welcome to the community...
You have nothing to worry about as long as you are honest and truthful regarding your application and any claims submitted you need not worry....Don't remember having a question like this before a person buys a policy...what has made you think along this line?
Posted: Wed Apr 30, 2008 05:10 am Post Subject: Fruad Cliams
Hi ,
Well if u face any such problem in future in that case you may contact Fraud Division Regional Offices of your country . The Fraud Division has been established for insurer who are suspecting insurance fraud. But it is very important to know that notification of insurance fraud may be made anonymously .
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