Kategorie: News
Why insurance companies refuse to pay ...
When it comes to insurance policies, there's nothing more frustrating than a rejected claim. After all, what good is insurance if it doesn't cover costs incurred?
Report by Emanuele Giacchetta / DAN Europe
At IDA, the DAN Europe Group's insurance company, the least desirable outcome is the rejection of a payment to one of DAN's members. Every year, the treatment costs of thousands of members are covered.
However, a small fraction of claims are rejected. When this happens, it is usually due to a few repeated errors in the claims process.
DAN Europe now provides information on the five most common mistakes that lead to a claim being rejected.
1 - Failure to notify the DAN Alarm Centre in good time
DAN members have access to a hotline: the DAN Alarm Centre. It is staffed around the clock and can be reached by phone, Internet call and e-mail from anywhere in the world.
Not only can you get professional help from DAN doctors and experts, but DAN can also guarantee to cover the costs so that no advance payment is required in an emergency.
However, if DAN is only called in after treatment has already been received, some expenses may not be covered by the insurance.
Note: Contact the DAN Alarm Centre as early as possible.
2 - Late notification
Suppose an accident has occurred and the accident victim was unable to contact DAN directly. This is not a problem per se, as a claim can still be submitted.
However, it is very important that DAN is involved within 14 days of the accident. If this deadline is missed, the claim may be rejected.
In the past, some policyholders have unfortunately been under the misconception that they need to wait until all medical treatment has been completed before they can start the claims process.
In fact, it is of the utmost importance that the insurance company is informed as soon as possible, even if you do not yet know how much the costs will ultimately be.
Tip: Be sure to inform the insurance company within 14 days of the incident.
3 - Maximum number of travel days exceeded
A special feature of many DAN insurance tariffs is the insurance cover for non-diving-related accidents.
With the Sport Silver insurance tariff, for example, you are insured for a maximum of 90 days per year against non-diving-related emergencies while travelling abroad.
Imagine the following scenario: A diver decides to travel to a country other than the country of residence for 2 months. After returning, there is still 30 days remaining on this tariff. Later in the same year, another trip is made, this time for 40 days.
In this example, 100 days have been ‘accrued’ abroad. Only the first 90 days are covered by travel accident insurance.
This means that if an accident occurs during the last 10 days of the trip that has nothing to do with diving, no insurance claim can be made.
Tip: Before starting the trip, check how long the insurance for non-diving-related accidents is still valid (ideally keep copies of the flight tickets / travel tickets as proof).
4 - General terms and conditions not read
DAN knows that reading insurance documents can be boring. But when it comes to personal wellbeing, taking a few minutes to review a policy can make all the difference. It's especially important to get detailed information about exclusions.
Relying on unqualified advice can also be risky. Friends may be great diving partners. However, when it comes to what is covered by DAN, they may not be the best source of information.
Ultimately, a claim will be accepted or rejected based on the content of these documents - not on what ‘anyone’ thinks is covered.
Tip: Read carefully what is covered and what is not. If in doubt, you can always check with DAN Europe.
5 - Incomplete documentation
To make an insurance claim, you need an invoice or other proof of payment and clear medical reports.
For example, let's say you have a hyperbaric chamber treatment, but there is no medical report showing why this treatment was necessary. Without a proper report from the treatment centre, the insurer cannot cover the costs.
Tip: Always request and keep all medical reports, proof of payment and invoices.
Making an insurance claim is no fun. Ideally, you would like to avoid accidents in the first place. However, if you do find yourself in such a situation, these tips are a good way to avoid further stress and ensure a smooth and hassle-free reimbursement process.
The author
Emanuele has been with DAN Europe since 2013 and is currently the Customer Experience Manager. The aim of his work is to make DAN as transparent and user-friendly as possible for its members.
More information:
alertdiver.eu/en_US/