Monday, February 05, 2007

Aviva Insurance- Having the cake and eating it?

STRAITS TIMES - Jan 31, 2007

'Pre-existing condition' strikes out cancer patient's insurance claim

Plan excludes coverage, but some rival firms say they would have paid

By Finance Correspondent, Lorna Tan

A 45-YEAR-OLD woman diagnosed with breast cancer thought her medical bill was covered by her insurance policy, but a rude shock awaited her.

Backed by medical reports, her insurer Aviva said that the 9cm lump found in her breast had begun growing before her policy took effect.

It refused to pay, saying her cancer was a pre-existing condition at the time that she signed up for her MyShield hospitalisation policy - never mind that she had no idea at the time.

Fortunately for Ms Simone Vaz, her company has paid for the bulk of her medical bills. She also managed to receive payouts from two critical illness policies, one of which she had signed up for at the same time as her MyShield plan.

Still, her case has turned the spotlight on an often-overlooked but vital issue in medical insurance - the definition of a pre-existing condition.

And the details of Ms Vaz's case underline the complexity of the question and the differing approaches of insurers in dealing with the question.

She signed up for a MyShield plan with Aviva here in January last year and it took effect on April 1. Based in Shanghai, Ms Vaz works as a communications manager at a telecommunications firm.

She was not required to take a health test by Aviva. Prior to that, the last time she had a health check was in 2004 when she applied for her China visa. Ms Vaz had never undergone a mammogram prior to the diagnosis.

The first indication that something was amiss occurred during a spa massage in Shanghai in mid-June last year when she experienced pain.

She saw a doctor in Singapore and was diagnosed as having advanced or 'stage three' breast cancer. The tumour in her breast was removed immediately at Mount Alvernia Hospital.

Her initial medical bill of $15,000 was rejected by Aviva on the grounds that\nthe condition existed before her policy was issued."

Aviva backed this up with medical opinion.

In a letter to Ms Vaz's lawyer, Aviva stated that independent medical specialists had advised that it would have taken three to nine months for the tumour to grow to 9cm from 1cm.

Ms Vaz's claim was rejected not because of non-disclosure on her part.

It was rejected because the Aviva plan excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.

Its 'pre-existing condition' clause states that 'any injury, illness, condition nor symptom which originated...prior to the policy commencement date whether or not treatment, or medication, or advice, or diagnosis was sought or received' is excluded under the policy.

When contacted on the rationale for its policy, Aviva's chief executive, Mr Keith Perkins, said that by having an objective evaluation on when an illness originated, it is protecting the interests of the majority of its policyholders.

This guards against potential abuse which may lead to higher premiums if claims go up. 'If we rely on what customers know, we'll never know,' said Mr Perkins.

Aviva receives about 5,000 MyShield claims per year and less than 1 per cent of\nthese claims are rejected because of pre-existing conditions.

Currently it has nearly 100,000 MyShield policyholders.

An insurance adviser told The Straits Times that Aviva's policy may come as a surprise to many medical insurance policyholders.

They probably assume that if they are unaware of a given condition at the time they sign up for the insurance policy, they would be covered, he said. And most of the time, they would be right.

A Straits Times check with rival insurers AIA, Great Eastern (GE), NTUC Income and Prudential found that they adhere to this principle and would have paid Ms Vaz's claim.

The clauses of GE and Prudential are similar. Prudential's clause states that a pre-existing condition is the existence of any signs or symptoms for which treatment, medication, consultation, advice or diagnosis has been sought or received by the life assured or would have caused an ordinary prudent person to seek treatment, diagnosis or cure, prior to the cover start date of this benefit or the date of any reinstatement'."

GE added in response to queries about Ms Vaz's situation that even if the doctor were able to estimate how long the condition had existed, it 'would not be fair' on the policyholder if the insurer declined the claim.

The clauses of AIA and Income are similar to each other, but more ambiguously phrased. AIA's clause states that 'any pre-existing illnesses, diseases, impairments or conditions from which the insured is suffering prior to the policy date...will not be covered', without specifying if the policyholder needs to be aware that he is suffering from the illness.

However, both insurers told The Straits Times that if a policyholder is genuinely unaware of a medical condition which is diagnosed only after the policy inception, they would pay the claim. AIA added that the insured must not have any symptoms at the time he took up the policy.

Aviva's Mr Perkins disagreed with that approach, maintaining that an independent medical opinion is crucial for an 'objective evaluation of claims'.

A clause based on customers knowing about an illness cannot be objectively evaluated as it relies on us knowing customers' personal knowledge,' he said.

'I'm not concerned that we're different from other insurers. I'm happy that we are.'


Ms Vaz said Aviva's pre-existing condition clause put an insured person 'at a complete disadvantage'. Her bills have skyrocketed to more than $70,000 due to the operation, chemotherapy and radiation sessions.

She added that her fear was that her health care would suffer due to a lack of finances when she retires or if she is retrenched.

Aviva gave her an ex gratia payment of $3,128 which she has not cashed in yet.

When contacted, a Ministry of Health spokesman said that private insurers can choose to impose additional exclusions on their Shield plans should the insured have any pre-existing illnesses.

The Consumers Association of Singapore (Case) executive director Seah Seng Choon said that in his view, the clause is 'not fair' to customers if they are genuinely unaware and have no intention of omitting information on a medical condition."

He added that if there is such a clause, the insurer should stipulate the timeframe for such pre-existing conditions and highlight the requirement to the consumer
(NB: Bold and italics are mine)

My comments:

Dear friends,

Aviva said: “Ms Vaz's claim was rejected not because of non-disclosure on her part.It was rejected because the Aviva plan excludes all pre-existing conditions regardless of whether there is disclosure or non-disclosure or whether the insured has knowledge of the condition.”

I feel the burning need to comment as it seems that Aviva’s policy-holders are in a severely disadvantaged position.

You Pay premium but Aviva may not pay when you send in claim

Even if one signed up with Aviva in good faith, not hiding any knowledge of any pre-existing medical conditions, Aviva can refuse to pay.

This is preposterous as even now, the body of knowledge about the Causes ( etiology) of Cancer is still very rudimentary. The theories of Cancer include, genetic predisposition,viral,environmental plus plus. ( a lot of time they mean "I don't know")

When a patient (let’s call him Joe) consults his regular doctor ( let’s call him Dr.Good) today (5th Feb 07), not even the most expensive test in the world, can say with 100% certainty that Joe does not have any cancer cells in his body.

Assuming Joe says, “Dr.Good, I am interested in buying insurance next week and I want to be sure that I am fit and have no pre-existant illnesses so as not to be accused of defrauding the insurance industry. Can you help me?”

Dr.Good, who is friendly and methodical ( but sensible and prudent), says,” Of course I can. Do you have any illnesses like hypertension, diabetes, history of family illnesses etc etc)
Because I am a good doctor, I will send some blood specimens for baselines checks and do an ECG.

BTW,I don’t think you need the expensive PET scan. Anyway, the Minnistry of Health, advises against using PET Scans as a screening tool unless absolutely warranted”

As expected, Joe passes the tests with flying colours and happily signs up with Aviva the next week. ( Boy- is Joe in for a surprise!!)

If 6 month’s later, Joe goes to see an ENT Surgeon, lets call him Dr.Me, and is diagnosed with early nose cancer and requires radiotherapy etc, Aviva can refuse to pay, citing the possibility of pre-existing cancer when Joe signed up.

It matters not that Joe and Dr.Good had vouched that they thought Joe was clear of cancer on the 5th Feb 07.

Even Dr. Me on the day of diagnosis cannot be certain at all how long the tumour had been there. It is all just guesswork and conjecture on the doctors’ part.

Now, Aviva is in a very enviable position.

If it does not want to pay- based on whatever reason, it can just get opinions from doctors and then use these opinions (and I remind you that these are just opinions ), to avoid the responsibility of paying! Some specialist on Aviva's panel- if forced to commit, could have said that " it is not inconceivable that some cancer cells could have existed prior to Feb 07" or something to that effect.

Have the cake and eat it! How nice and convenient!


Salma Khalick agrees with Aviva!??

(ST: 5th Feb 07) Salma Khalik: Aviva did the right thing in rejecting cancer claim- ( read here for article)

In my opinion ( yes that word again), Aviva is wrong. Salma is just as wrong to sanction Aviva’s actions.

She mentions motherhood truths about why buying insurance early is better and why one should be responsible for one’s own healths etc. What has all that to do with Ms Vaz’s case?

Ms Vaz, bought insurance which she thought would help her when she contracts some dreaded illness later on. It is a tragedy that she finds herself with an unexpected cancer.

The sense of tragedy is compounded now that Aviva has found some excuse not to fulfil its obligations.

Any action from anyone?

Some regulatory bodies and consumer advocacy groups should be looking into this!

I will be buying magnifying lens to pour over the fine prints in my insurance policies!

Dr.Huang Shoou Chyuan

42 comments:

Dr Oz bloke said...

Maybe they all have shares in Aviva?

I agree. It is very sad that insurance companies are now putting such "clauses" so that they can collect premiums and yet have the chance that they can get away without paying out anything!

Excellent business sense! And the media and government supports it! Isn't that wonderful?

What's next? In future if you die and they could show that there was doubt that the death had nothing to do with how you lived your life, then they won't pay cos u caused your own death?

I think maybe I should stop buying insurance and instead put that money into the shares of insurance companies!

Anonymous said...

There is a very simple solution to this. Take note of the insurance company whose practices you deem not honourable and then DONT BUY from them. Also go tell all your relatives and friends not to have anything to do with these companies. Spread the word around. Insurance companies are business organisations in the first place. Compassion is never in the equation. They need your business and your premium (money) and the only way to deal with them is not to give them business. If enough people avoid them like pariah it will hurt them.

chow kar

nofearSingapore said...

Hi drbloke and chowkar(anon):
You just read Perkins words.

He is saying:
Buy Aviva ... BUT when you claim, only when medical specialists confirm that your condition definitely started after you bought the policy will we pay!!!

Hahaha!
You think doctors like us are not humans? That we can tell exactly ( with day and date) when the first cell had undergone malignant change?

Perkins is in for a career change!
(could be either direction)
Dr.Huang

the Stark in Winterfell said...

Arent Insurance Companies similiar to those MLM companies out there? Perhaps this is one of the reasons why they like to ...for lack of a better word...play with the customer...

Speranza Nuova said...

Dear Dr Huang,

I have written an article that seeks to analyse Aviva's stance, and the can of worms it opens:

An Insurance Problem: Whack By The Future

Hope it helps. As an experienced doctor, your input and comments would be most welcome. :-)

Best wishes,
Speranza Nuova

travailingdoc said...

Hi Dr. Huang,

There must be publicity about such exploitation of the insured by insurance companies.Thank you for doing this.

Firstly, avoid these insurance companies. It may bring to highlight the importance of pre insurance physical examinations.
Another read the clauses, but unfortunately you do not get to read them until after you have paid the premiums. Singaporeans must exert their rights.
I remember wanting to buying some insurance and I requested of the agent that I want to read the terms and conditions and I was given a multitude of reasons why I cannot read a sample contract.

What balooney!!!! I did not buy from that company.

These companies are making bundles of profit and using legal semantics to get out of their moral responsibilities is despicable.
They can see that the lady was acting in good faith when she bought the insurance, but the company did not response in kind.
Get everybody out of Aviva.
By the way is Aviva a French company that took over the local insurance company. I may have a life policy from them because of their takeover. I may consider discontinuing my premiums and get my surrender value.

Cheers all

Dr Oz bloke said...

Perhaps the flip side of the coin is that it is possible for people to "pretend" that they do not have cancer eg a breast lump when they suspect something is wrong, sign up for a policy "in good faith" and then subsequently seek help for the problem and hope for the insurance company to cover the costs?

How do we weed out these people who try to exploit a loophole in the system?

I guess there are 2 sides to the coin.

There is however no such thing as compassion in the business world.

And for those medical advisors who "certify" that the cancer started before signing the forms....well I am sure they could also say that there is no way they can rule out the possiblity that the cancer started AFTER signing the forms.

But of course the question is who is paymaster?

Suppose the situation involved a prominent figure, a politician or a very rich billionaire. Would the same have happened?

travailingdoc said...

Hi all

There will always be those who will pull a fast one and agreeably, these people should not benefit from their wrong doings.As doctors we often come across those we have made a diagnosis of cancer or had offered surgery or expensive treatment, and they want to purchase health insurance straight away.
Looking back at the facts , I have to agree, it highly implausible to buy a policy in April claiming she was not aware of anything unusual then but to have a 9 cm breast mass later diagnosed in June . That makes the growth to be a phenomenal rate of about 1 mm a day if her claim is true that the tumor grew to that size in just 3 months from an insignificant entity. .Unless she is as endowed as Dolly Parton, most Asian women have mammary gland sizes not much larger than 9 cm.. So such a sizable mass will have almost engulfed the whole breast. Hard to believe she did not notice anything was amiss all this time The only tumors to have rapid growth rates are poorly differentiated Ca or lymphomas.
Now most Ca breast are adenocarcinomas if I recall, and I believe they are not that rapid growers. I guess the doctors who submitted the case for Aviva must had looked at the histology and its grade of differentiation.
But we must have all the facts before we can make any fair comments.Sorry for being too technical for those not initiated.

Having said that, this does not detract from purchasers of insurances of any kind to always read the fine print. Ignorance is not an excuse in the eyes of the law.Insurance companies are business vultures as someone had mentioned.

Cheers

nofearSingapore said...

Hi all,
The point about Aviva is ( I think),
they are not sure ( to put it mildly) about the bona fide of this claim.
They cannot prove any fraud... but still don't want to pay.
Most other insurance companies would do their damnest to show that customer had knowledge of pre-existing illnesses ( eg seek prior medical consultations) but failing to prove this, they would have no choice but to pay . After all this comes with the territory. Win some lose some.
What Aviva has done is very discomforting to all Aviva policy holders as NO ONE dares to arrange for any major surgery or investigations after this as they may end up paying for it themselves.

Like Dr. Lee Pheng Soon ( ex-SMA president) says, the only course for these Aviva policy holders would be to get admitted into the subsidised C Class beds if they need hospitalisation.

So now, Aviva has it good ( for a while till the next time they realise all their customers has jumped ship), as very few claims in extensive private hospitals/Paying class govt hospital beds would come in for the next few quarters!
After that Perkins would either be the Hero or the Goat (scape)!

Dr.Huang

Simone said...

I was directed to this website by someone who thought I might be interested. I submitted the following letter to Aviva as an open letter, but the Straits Times chose not to publish it. As the person being written about, I have been voiceless in this debate. I submit my comments below:

I write this as an open letter to my insurer, Aviva. There has been some discussion about my breast cancer claim to Aviva - which the company has denied under the pre-existing condition clause - since the Straits Times ran a story on this on January 31, 2007. In the ensuing discussion, and upon reading the comment piece by Salma Khalik in The Straits Times, February 5, 2007, I feel one key point seems to have been overlooked, and that is: is the pre-existing condition as stated in Aviva's contract fair to the policy holder?

Consider the following:

a) the integrated insurance plans where Singaporeans were allowed to use their Medisave funds to pay for a private insurance plan came into effect, according to the MOH website, on July 1, 2005 or about 19 months ago.

b) Aviva's clause, which excludes all pre-existing conditions, would therefore almost certainly exclude most cancers, since many would have pre-existed from July 2005 or before. My question is: how far back does this pre-existing condition clause stretch? To conditions pre-existing from July 1, 2005? Or earlier? From childhood, perhaps? How far back would be deemed fair and reasonable? This needs to be spelt out in the contract, and by your insurance agents.

Considering that many major illnesses would have their roots prior to July 1, 2005, I wonder how many people will see their claims denied in future because of this clause? Think of the possible scenarios - the forgetful person who is later diagnosed with Alzheimers, for example, or the asthmatic who is misdiagnosed and later found to have lung cancer. Witness the recent reportage on sudden deaths in Singapore - how many of these people might have had an undetected, pre-existing condition?

c) In the Aviva contract, there are two limbs under the clause for exclusion: prior knowledge, and a pre-existing condition, with or without prior knowledge. The hard line that Aviva has taken would imply that that prior knowledge is irrelevant. The fact that the condition exists at the time of policy commencement is sufficient grounds for exclusion.

My question: if knowledge does not matter, why have this limb in the contract at all? It is misleading to the layman, implying that one needs to satisfy both limbs before a claim is denied.

Finally, I say: Aviva, be fair to the people you are insuring. If other insurance companies seem to be willing to be more flexible for equivalent annual premiums for a private Shield policy, why aren't you? You hold in your hands, through your insurance policies, the power to determine the quality and extent of medical care people receive, and as a corollary, the chance of survival of dread diseases.

You claim that the clause as stated is essential to keeping premiums low. What higher costs are you protecting your policy holders from, that other insurance companies do not seem to have?

This discussion goes beyond my individual case - it affects all Aviva policy holders who need to know, unequivocally, under what conditions their insurance policies will - and will not - cover them.

nofearSingapore said...

Hi Ms Vaz,
I am sorry that this predicament has caused so much distress to you.
I hope you are recovering well from the surgery.
I am just as incensed and have recently written a letter to the forum page.
I will wait a few more days to see if it gets printed.
I will then decide whether to send it elsewhere or post it here.
You may like to know that almost all my acquaintances think that Aviva is wrong.
Best wishes,

Dr.Huang

Mohammad Najib said...

I am disturbed and slightly enraged.

No, I am not enraged or disturbed with Aviva or their policies, but by the level of outrage that has developed as I read through the comments.

Why is it that when a company or an organization is put into the limelight for an unpopular or seemingly wrongful action or stand, we beat it down like as though they owe us something?

Let me put a disclaimer that I do not work for Aviva. In fact, I am one of their policy holders, MyShield as well.

What is it that they owe you guys to recive such enraged remarks and comments? If you want an explanation, they have given you one. If you do not like what was said, there is no need to bad mouth them nor is there a need to "spread the word". Pull the plug on the policy and go on to another.

Accusing them of "having a way out to not pay us" is terrible. That is tantamount to accusing them with fraud. What is with the attitude that "they are wrong" and everyone must know?

Are they wrong? Or is it YOUR opinion that they are wrong? It is mind boggling to me as to how quick it was to highlight (in bold) what was felt as "wrong", and at the same time so easy it was to leave out the reasonings that we might need to consider.

If it was really their intention that this was a way out for them to not pay us, well i am sure then that more people would have been affected and not "less than 1 percent of the claims" (unless you have missed that out because it was not bolded).

According to other insurance companies, they would pay. Of course they would say that! They are not the one that will be paying her bill. But let's look at their clauses for AIA and Income, which is ambiguously phrased which I feel is worse since even if you DO read the terms and conditions, you might end up like Ms Vaz or worse, fighting a legal battle for your money over an ambiguously phrased policy.

At least Aviva is straightforward and detailed in their terms and conditions. That goes the same for GE and Prudential. Kudos to them for that. Which brings me to my next point, the terms and conditions. I do feel pity for Ms Vaz, and I wish her a good recovery, but this situation would have been avoided if she had read the terms and conditions. I do admit, I did not read it as well. I am sure there would be people saying that my thoughts would be different if I had been the one in the situation instead of Ms Vaz. I would incline to agree but I would still feel that it is my personal fault for not reading the terms and conditions. And, please do not raise the issue about insurance companies withholding their terms and conditions as so far it has never happened to Aviva and totally unrelated to the matter at hand.

There are views that it is unfair for them to include such a clause. I agree it might be unfair. But I feel it is also unfair for us to EXPECT them to change just because other companies are willing to pay and they aren't. Again, why don't you just drop Aviva and sign up with other companies? I am considering that avenue but be rest assured that there are always skeletons in the closet for each insurance company out there. Does that mean we shouldn't take up insurance?

Instead of passing the word around, I would rather learn something from this incident. That is, take it upon yourself to have a medical examination before any policy sign up. In fact, I feel it should be necessary and perhaps if this is made mandatory, this "dubious" clause shouldn't pose a problem anymore. Secondly, read the terms and conditions. Might take long, but well, at least you know what you are going into. Lastly, please do take a step back and try to understand for both parties why some policies are in place. And if it is unfavorable to you does not mean it is unfair to everyone. If you decide to drop the policy, you are doing it because you have understood the policy and it is not the coverage that you had in mind, instead of doing it because you felt they have cheated you or withheld information fom you.In the end, the reason we took up insurance is because we are responsible people who make sure that the people we love will not suffer through our misfortunes. Please uphold this responsibility, even if it means reading through pages of terms and conditions or taking a day off to go through a medical examination.

Organ harvesting said...

Hi Dr H.,

Not related to this entry but another earlier one that you posted.

http://nofearsingapore.blogspot.com/2007/01
/organ-trading-what-next-is-there.html

Matrix Island entry today Thursday, February 08, 2007 about how SGH enforced Human Organ Transplate Act, with police+hospital staff etc fighting against the dead man's family.

http://matrixisland.blogspot.com/2007/02
/knee-down-all-you-want.html

What are your views on it? Esp as a medical professional you may have seen more such cases and the emotional trauma of the families (both donor and recipient). Thanks!

Just my 2 cents worth... Somehow I find each of the above blog entries disturbing, and worse when one put both together. Even though I agree with organ donation in principle, I now have my doubts and may opt out.

nofearSingapore said...

Hi:
Mohd Najib: You are entitled to your opinion. However, I stand by 100% behind what I have said.
All the more since I found out from another source about Ms Vaz's circumstances leading to her discovery and subsequent surgery ( No, these new info is not from MsVaz).
In fact it was a pure coincidence how I found out that Ms Vaz had been truthful and there was no attempt to hide any knowledge of pre-exitant disease and hence the outcome for her has been extremely unfair!

No, Mr. Mohd Najib, Aviva's practice is certainly not acceptable. If you accept such behaviour, good luck to you whenever you are at the receiving end of any purchase or service.

Organ harvesting: Your comments are more appropriate at the other posting. I will copy you comments there and add my comments to it there.
Thanks

Dr.Huang

travailingdoc said...

Hi all,

In a truly free country one can speak his mind as long as it is not defamatory.
In a civilised country, matters of public concerns are arenas for comments by the populace.This is sacrosanct.
Health insurances are indeed issues of the highest importance, as it involves life and death issues.

Health insurance companies are not naive angels,and
are known to be not always open in their dealings with their policy holders.

I hail Dr. Huang to stand out there and be a voice while others will shirk behind skirts while tearing down in such self righteous and indignant hypocritical manners against those who are speaking out for the interests of all including those who don't think so in this forum.
Be it as it may, everyone is entittled to his own opinion, including those whom you strongly do not agree with . It is not
within anyone's purview to tell
someone to shut up just because you do not agree with him. BY all means present your arguments . Let the better argument prevail.

Cheers

Simone said...

Dr Huang, I thank you for drawing attention to the pre-existing condition clause on your blog and look forward to reading your letter, either in the Straits Times or elsewhere. TODAY seems to be a good public commentary forum!
Thanks again.
Simone.

Chris said...

Hi

the only thing that can be said of Mohd Najib is that he is entitled to his opinion.

He is, however, not one in support of "people power" or "for the greater good".

I am a parent of 2 kids and i think it is a sad day if i were to tell them to tolerate injustice in the world and "move on", "turn the other cheek" so to speak.

it is a sad day indeed if we all do that, and the world would remain at its then stand still state.

i believe that human beings are able to enjoy the situation that we are in today due to our desire to improve, and want to tell others of the improvement.

"Moving on" is not quite an improvement. Think about it, if the people of Philippines "move on" we'd still have Marcos in power today.

shimure said...

Hi Doc H,

Insurance companies advertise that they will take care of you when you take up this premium or that premium. However, when something happens to you, instead of living up to the promises they would take months if not years to pay you. Moreover, they will give 101 excuses not to pay a person. after all 101 excuses have been used they will say if you are unhappy we will see you in court.

They forget the importance of integrity and the need to maintain their reputation.
Their reputation is like a mirror, once broken can never be repaired.

I applaud you for bringing this case to my attention. I will take note of Aviva and not purchase any policies related to the company.

Thank you.

Anonymous said...

I am refering to Mr Mohd Najib's posting. All I can say is that he is very naive and obviously totally ignorant about medicine. He has a very simplistic believe that all he has to do is to go for medical check up before signing up for a policy. Does he know that it is very very very difficult to detect early cancer especially if there are no presenting signs and symptoms. Unless one goes through all the tests for every organ system in the body a routine medical check up often does not reveal your condition. Let me give you an example. Support you have a very early cancer of the pancreas for which you have no signs and symptoms. Would your average medical practitioner order tests for your pancreas? How many tests must he order and for how many organ systems? How many times have specialists face with the sad prospect of informing their patients that they have cancer only to be told by patients that they just had an all clear checkup?

My Najib, that is why we buy insurance for. We do not know what is in store. And we expect insurance company to be honourable. Yes they owe as as we are paying premium to them. And yes we must spread the word around for the sake of others.

nofearSingapore said...

Hi Simone and all,
The ST finally printed my letter ( albeit edited)
The original letter is as follows:

February 6, 2007

Aviva’s policy does not give assurance!

Dear Editor,

Aviva’s stand on the definition of “pre-existing condition” is shocking!

Any Aviva policy-holder will have no assurance (pun intended) whatsoever, that after having been discharged from hospitalisation and surgery that Aviva will not reject the claim for reimbursement.

According to the previous news article by Lorna Tan (STRAITS TIMES - Jan 31, 2007 'Pre-existing condition' strikes out cancer patient's insurance claim’,
awareness by policy-holders of any pre-existing conditions is immaterial to Aviva and “an independent medical opinion is crucial for an 'objective evaluation of claims'”

Doctors’ opinions ( NB:these are only opinions) will be crucial and I wonder which of my colleagues can, with certainty, know whether a certain claimant has a pre-existant cancer at a given point in time.

Any cancer, after all, starts with one single cell and this one cell is invisible to even the most eagle-eyed observer.

Also, even large cancers often remain completely asymptomatic to even very health-conscious people. Annual medical examination often do not detect these “silent” tumours.

It seems to me that Aviva is in an enviable position and risks being labelled as a “bully”.

Dr.Huang Shoou Chyuan
"end letter"
This is my last word on this issue.
I have no personal axe to grind with Aviva.
Best wishes all

Faeline said...

I'm not looking for people to throw stones at me, just a few thoughts.

I bought myShield as well, and when I first read this news, I was alarmed. I read it a few times, to know what happened. The first thing that came to mind was that Ms. Vas did not take a medical examination just prior to the signing of the insurance. Will such a problem occur if she took a medical examination right before she bought the policy?

As for breast cancer, although I have never suffered from such a terrible illness before, my sister did have a scare recently regarding a 1cm lump in her breast. It was a benign tumor which she removed immediately. Even for me, before she went for the surgery, the lump was quite visible to me.

I wouldn't say that Aviva is faultless... the existing clauses can possibly be said to be ambiguous, but part of the blame lies with Ms. Vas as well, for being careless - with her health and the terms and conditions.

There are many sides to this situation I think. I mean, there are people who'd try to cheat the insurance companies, and a company being careful, is also being careful about our money. (I wouldn't say whether they are being overly careful to a fault here.)

I'm sure I'll be angry if I'm in Ms. Vaz's shoes, but I guess sometimes, it's not always a single person/company's fault. It could have been both Ms. Vaz, Aviva, a whole lot of isolated seemingly unrelated issues that led to such a circumstance.

faeline said...

And sorry about the spelling error, Ms. Vaz.

Jimmy Mun said...

I am not an Aviva employee, just a policyholder. I believe Myshield will cover a pre-existing condition PROVIDED the insured has another shield plan prior to switching to Myshield.

I suspect Ms Vaz doesnt have any shield plan prior to signing up to Myshield, ie she even opted out of the basic Medishield package.

Then out of the blue, she signs up for the most expensive shield plan in the market with the most generous benefits, and within 6 months, finds herself with breast cancer, a 9cm lump no less. You dont think this is a little fishy? If Aviva is a real nasty bully, she could be charged with insurance fraud.

Of course we should give Ms Vaz the benefit of doubt, and she is probably just a busy executive too numb to listen to her body, and that she is just a case of bad luck/bad timing. But I certainly do not agree that Aviva is behaving like a bully in this case. Compare this with, eg NTUC Income's 7 day in advance notification of hospitalisation or else coverage not guaranteed. Now that is bad.

mohammad najib said...

Wow. Just, wow.

Judging from the tones of the comments referring to mine, I believe first and foremost I should apologise if my previous comment had offended anyone.

To reply to the comment made by Chris, I have to agree that I do not champion "people's power" but I do favor it over "just moving on". I do not champion it because, to be honest, even I myself cannot determine if I am championing the right thing. But if there has been injustice done, I would stand up and say so. So why do I say "let's move on"?

Because, by looking at what is at hand, so far I do not see an injustice done. Please, there are much more injustice done out there which makes this "injustice" looks like peanuts.

As I have said, show me another case or a few other such cases and I will be swayed to your side. And if you do not find that there might be some suspicion in Ms. Vaz's side then I believe you are not assessing the situation well enough.

As pointed out by shimure, I may be naive and am clueless about medicine. I accept that for I am just an IT guy. But lets look at someone who I believe knows what he is saying. In one of travailingdoc's comment he was assessing the growth of the tumor and he believes that it would be hard to believe, not impossible, but suspicious that the growth was not detected and if it really had started that late, it would also be too suspicious that it grew so fast. This is a vast vast comparison with the pancreas cancer that you have used as an example.

As shimure said, it is very hard to detect the signs of cancer at an early stage, I agree. But it would be as difficult to prove that it has existed since then. But in Ms Vaz case, it is almost certain that it had occurred before hand. Have you checked how many cases Aviva have reimbursed cancer patients? Did they suspect these cases? I am sure that pancreas cancer you have mentioned would have been one of their cases. And I am sure as well it would have costed them even more than what they had to pay out to Ms. Vaz. On top of that, with accompanying decisions she had made as commented by jimmy_mun does make her look suspicious.

Once again, it is just but one case, which I feel can go both ways. If I were a friend of someone who is intending to take this plan up, I will tell him the clause, but I do not think it is fair for us to put such negative conotations to it. At the end of the day, it is a clause, and to some extent, it does protect the policyholders. If you do not see this point as well, then I believe you have not assessed it enough as well.

I believe that what we shoud teach our children is not championing for the "greater good" or "people's power" because if you have read history and even now, there are many people championing "people power" and the "greater good" but only achieved mayhem and destruction. What our kids nowadays should learn is how to assess a situation, step back and look at all angles before making a stand. It might still not be a right one, but at least we do not jump at every injustice we see blindly, thinking the people are always right and the big people up there are wrong. But if after assessing a situation, and "the people" needs to step in and be championed, then by all means do so. But as I analyze my statement, I would probably be told that I might not have experience in raising kids. Unfortunately I have to agree with that since I have none. But if that stand makes me naive, then I will stay naive.

To me, the greatest evil is when a cause is championed for the "greater good" but neither the cause nor the "greater good" is known.

Anonymous said...

When i read the postings of faeline and mr najib i can't help but respond. Faeline you cannot see a 1cm tumour of the breast. Doctors have been known to miss out even larger tumours. In my years of practice as a specialist, I have seen cases of tumours that have escaped detection until much later.

As for mr najib's reference to the travellingdoc's opinion, have you found out if he is a breast specialist or an oncologist? Over the years I have filled out countless number of insurance forms. Estimating growth rate of a tumour or deciding when the lesion first occurs is at best an educated guess. Even amoung specialists, opinion defers and are sometimes poles apart that you wonder if one of them is insane.

Lone Ranger said...

I signed up MyShield Plan 1 on 1 August 2005 at an annual premium of S$400. However, I did not hear from them till I received their letter dated 7 March 2006 to welcome me as their policyholder after I followup with them on 27 February 2006.

My regret is that I should have objected that my policy commenced from 1 April 2006 till 31 March 2007 although I signed up 8 months ago.

During these 8 months, I had heavy non-stop bleeding, and I went for myomectomy on 1 November 2006. I had a rude shock when I tried to claim from MyShield. They claimed that my condition existed before the policy commenced, ie, 18 March 2006, hence the policy would not provide coverage for pre-existing condition.

I was so disgusted with their inefficiency and what other choice did I have but to terminate my policy immediately! I guess the main reason why we buy medical policies is to have some peace of mind that our medical bills are taken care of but instead I felt cheated and ripped off!

Based on my own personal experience and the stories that I heard, my advice to those who are contemplating of purchasing medical policies, do not purchase from AVIVA as it is not a win win situation when comes to claims.

king said...

Insurance rate is a factor used to determine the amount, called the premium, to be charged for a certain amount of insurance coverage. Risk management, the practice of appraising and controlling risk, has evolved as a discrete field of study and practice.

Anonymous said...

even if the assured had the basic medishield in place. and after the condition occurs, she signed up for enhanced plan, the condition will still fall under exclusions. Therefore, this is a very good example of "Even you want to buy insurance, insurance company might not want you", therefore consider do something about it before its too late.

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