Exclusion by Insurance company for upfront declaration of family history

Akins

New Member
Joined
Oct 17, 2018
Messages
9
Your advice and opinion on this issue will be appreciated.
I recently received a counter offer letter from one of the insurance companies in which exclusions were placed on the policy with regards to glaucoma (an eye condition). The insurance policy was meant to cover life, critical illness and disability.
While completing the forms , I ticked the portion of family history of glaucoma because my 70 year old mom was diagnosed with this condition a few years ago as an incidental finding during her annual eye check (she is fully sighted up till now).
I subsequently saw an ophthalmologist to check my eyes and conduct tests for glaucoma. The specialist, after evaluation concluded that I do not have glaucoma and sent me a report with all the results of tests conducted.
All these were sent to the insurance company upon request about 3 weeks ago. All the other tests (blood and urine) conducted by the insurance company were normal. I am surprised at the decision on the offer letter:

*DESCRIPTION OF TERMS OFFERED BY ....(insurance company)..........
AA04L
Exclude glaucoma, or consequences thereof, or any related disease or disorder pertaining to this condition, including any treatment and complications of either the treatment or the disease or disorder itself."


The questions in my mind are :
1. Is it wrong to truthfully complete insurance forms ? (The recent Momentum insurance and blood sugar non declaration is still fresh).
2. Do declaration of an illness in a family member result in penalisation of the applicant?
3, My declaration is based on my awareness of this diagnosis in a family member. What of if I was not even aware?
4. While I have not been diagnosed with glaucoma at this time, if I get diagnosed in say 20 years time what happens with the insurance cover.
5. If I get invoked in a motor vehicle accident and suffer disability, won't this insurance company run under this exclusion to avoid a payout?
I am inclined to reject this offer as I do not want to throw money into the sea.
Kindly advise
 

pinball wizard

Honorary Master
Joined
Feb 9, 2010
Messages
14,843
I subsequently saw an ophthalmologist to check my eyes and conduct tests for glaucoma. The specialist, after evaluation concluded that I do not have glaucoma and sent me a report with all the results of tests conducted.
All these were sent to the insurance company upon request about 3 weeks ago. All the other tests (blood and urine) conducted by the insurance company were normal. I am surprised at the decision on the offer letter:

*DESCRIPTION OF TERMS OFFERED BY ....(insurance company)..........
AA04L
Exclude glaucoma, or consequences thereof, or any related disease or disorder pertaining to this condition, including any treatment and complications of either the treatment or the disease or disorder itself."
Based on that I would escalate to someone in senior underwriting if you want to stay at this company, or look elsewhere. Also, just tell us who it is. I personally hate when people on this forum make us play guessing games.

Where the **** is that things that irritate me thread when I need it.
 

tRoN

Executive Member
Joined
Mar 13, 2007
Messages
5,568
If that’s what the underwriters offer you for their policy then you could accept, appeal or decline and move on
 

Akins

New Member
Joined
Oct 17, 2018
Messages
9
Based on that I would escalate to someone in senior underwriting if you want to stay at this company, or look elsewhere. Also, just tell us who it is. I personally hate when people on this forum make us play guessing games.

Where the **** is that things that irritate me thread when I need it.
It is PPS.
Below is an extract from my broker's response on the issue:
"I discussed the matter with the head of underwriting and the reasoning behind this is that because of the family history they feel that the risk is already present"
 

pinball wizard

Honorary Master
Joined
Feb 9, 2010
Messages
14,843
It is PPS.
Below is an extract from my broker's response on the issue:
"I discussed the matter with the head of underwriting and the reasoning behind this is that because of the family history they feel that the risk is already present"
Take your business elsewhere.
 

rietrot

Honorary Master
Joined
Aug 26, 2016
Messages
14,066
Move on and find a better insurance company. The exact reason for the disability cover is to have this covered.

If they want to derisk this policy by not covering your actual risk then what is the point? if you have a chance of getting glaucoma then they should specifically cover this not exclude it or they should offer you extremely favourable premiums.
 

pb41

Active Member
Joined
Feb 21, 2008
Messages
71
In my experience PPS is extremely strict at the underwriting stage. This is probably not a bad thing as otherwise you could land up with the Momentum scenario where your claim gets repudiated years later. Better to disclose fully upfront and know that you have proper and reliable cover, subject to certain exclusions.
 

tRoN

Executive Member
Joined
Mar 13, 2007
Messages
5,568
In my experience PPS is extremely strict at the underwriting stage. This is probably not a bad thing as otherwise you could land up with the Momentum scenario where your claim gets repudiated years later. Better to disclose fully upfront and know that you have proper and reliable cover, subject to certain exclusions.
The issue here is that he “does not” actually have a preexisting condition but a family history which may never occur in him. As mentioned your broker can appeal by getting a report from an ophthalmologist.
 

Akins

New Member
Joined
Oct 17, 2018
Messages
9
This is to thank everyone on this forum for their input and advice. I will be speaking with another broker soonest. It's just that a number of these guys are on vacation at this time
Much appreciations to you all. Have a splendid holiday season.
 
Top