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Table of Content
1. Generally speaking, how long does an insurance claim usually take?
2. Is the claims processing time for “Hang Seng HK$180,000 protection” too long?
3. Is it normal for an insurance company to establish its claims criteria at the outset and subsequently require further evidence?
4. If the claims process is considered too lengthy, what can the insured do to lodge a complaint?
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Hang Seng’s HK$180,000 coverage dispute remains unresolved: Is the claims process too long? Q&A answers
Hang Seng Insurance launched a “COVID-19 Diagnosis Supplementary Cover” (known as the “Hang Seng $180,000 Cover”) earlier this year, and was involved in a controversy over the “refusal to insure” or “refusal to pay claims” in recent months.
More recently, policyholders have complained that, after fulfilling the claims requirements for the relevant insurance product, Hang Seng wrote to request that the relevant medical institutions provide additional information about the policyholders, stating that the deadline for submitting the documents could be as long as 180 days from the date of diagnosis. Is Hang Seng’s claims processing period too long? Is it requesting too much information?
1. Generally speaking, how long does an insurance claim usually take?
Once the insured person makes a claim with the insurance company, the claims process will commence immediately. The length of time required to process the claim depends on the complexity of the product, the claim amount and the insurance company’s administrative procedures.
In general, simple online products can be processed immediately. However, some products, such as medical insurance, are more complex. In particular, if an early claim is involved, the claims process may take several months or even more than one year, depending on factors such as the progress of processing medical reports and the insurance company’s administrative procedures.
However, the “Hang Seng HK$180,000 coverage” add-on itself is not complicated, and the compensation amount is the same for all insured persons. The insurance company only needs the insured person to provide a nucleic acid (PCR) test result and a registered doctor’s confirmation that the insured person has tested positive, after which it must pay the compensation.
2. Is the claims processing time for “Hang Seng HK$180,000 protection” too long?
It is understood that the letter from Hang Seng to customers mentioned that, for the claim in question, a medical institution would need to provide a medical report. It also pointed out that, due to the pandemic, doctors or medical institutions might need more time to provide documents and proof; therefore, the deadline for submitting supplementary documents was set at up to 180 days from the date of diagnosis.
As mentioned above, the product structure of the “Hang Seng HK$180,000 coverage” is not particularly complex. Unless the case itself involves special factors, the medical institution encounters difficulties in processing the documents, or the insurer has a backlog of claims and takes an excessively long time to process them administratively, the claims process should not take as long as 180 days.
3. Is it normal for an insurance company to establish its claims criteria at the outset and subsequently require further evidence?
First of all, from the insurance company's perspective, the disclaimer clause in the claims form also states that the insurance company reserves the right to request further information or records from the insured person.
When an insurance company requests information from an insured person, this usually involves two principles — taking the “Hang Seng HK$180,000 cover” as an example, the insurance company may wish to confirm the insured person's history of being diagnosed with COVID-19, or whether the insured person has triggered any exclusions, such as being diagnosed during the waiting period or there being evidence of deliberate infection.
According to the letter from Hang Seng Insurance to medical institutions, there is indeed a reasonable basis for Hang Seng to ask some of the questions, such as whether the insured person had taken a rapid test before being diagnosed and the method used to conduct the PCR test.
Examples:
Is there any Rapid Antigen Test done for the patient before first consultation?
Was the specimen collection of PCR test performed in person by your clinic?
However, some questions may not be closely related to the “Hang Seng HK$180,000 cover”, such as the medical consultations and surgeries previously provided to the patient by the medical institution, and whether the patient regularly visited a hospital or clinic for check-ups or examinations. The answers to these questions do not affect the fact of whether the insured person was diagnosed with COVID-19.
Examples:
Please list details of all medical conditions that your patient has consulted you.
Did the patient have any routine check up in your hospital/clinic? If so, please provide details.
The only possibility is that the above questions may concern whether the insured person failed to disclose certain information when purchasing the insurance, resulting in the insurance product they originally purchased being declined.
4. If the claims process is considered too lengthy, what can the insured do to lodge a complaint?
We believe that the insured person can afford to wait patiently at this stage, as the insurer has not yet explicitly refused the claim. We believe that if the insured person fully meets the claim requirements, the insurer will ultimately be unable to refuse the claim.
However, if the insurer does refuse the claim and the insured person considers the reason given to be unreasonable, we recommend lodging a complaint with the insurer concerned. If the dispute cannot be resolved, the insured person may consider referring the matter to the Insurance Complaints Bureau, with legal action as a last resort.
We believe that, in respect of the claims mechanism and the procedures and timeframe involved, insurers should improve transparency and communicate more with the public and their customers to reduce the likelihood of misunderstandings.
Note: This article was last updated on 24 May 2022
This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.
10Life Editorial Team
Our team of professional content researchers focussing on insurance
10Life Editorial Team
Our team of professional content researchers focussing on insurance
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