Existential Problem
When pre-existing becomes an existing problem how to deal with it before it happens.
Pre Existing!
So many people choose a product for their health solely on price as they have no further information as to what to choose.
Can you imagine paying for health insurance and when it came time to use that health insurance the provider told you that due to a technicality in the policy wording you will not be covered. That is an existential problem that is based on pre-existing conditions and a lack of knowledge.
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Let me tell you that the wording in the policy is like the tyres on your car it’s the only connection you have between staying safe on the road and sliding off into the paddock at the very first turn. If you don’t understand, didn’t read or did not seek advice on the wording of your policy then you really are just taking chances with your health cover that you may have to pay for with your health and your bank account at a later stage.
As I always say the best type of health insurance is the insurance that you don’t ever need but if you do need it, it does what you paid for. Policies in the US are sold with wording that could just leave you all alone in your moment of need, if your policy has a blanket clause like ‘pre existing medical conditions are excluded’ then you know when the time comes to make a claim for something serious like cancer treatment your provider will be fighting tooth and nail to prove that it was possible that you had cancer prior to taking out your policy. Then the real fight starts, as you have no further means of protection you will either accept the position of the provider and pay for something, that should be covered by your policy, out of your own pocket or you will litigate. If you are forced to litigate you are going to be facing some pretty big outlays and going up against a foe with some very deep pockets.
So why point this out?
Well if you were to take out a policy with UK wording not only would you have the initial protection of a slight variation in the wording, that would give you a huge advantage in the court room, but you would also be able to take advantage of government oversight, regulation and intervention. What is this small but significant variation? UK worded policies are more along the lines of ‘pre-existing conditions that you could not reasonable have known about are excluded’ small as it may seem in the beginning these words give you the benefit of the doubt in the situation where you develop a medical condition that needs attention and even if it was existing at the time you took out your policy if you were not seeking medical advice, intervention, not medicating and if you had no symptoms of this condition then you could not have reasonable known about it. After you have taken the first step of having your broker go in to bat for you you will have the following steps, prior to even thinking about litigation.
UK Ombudsman
The UK Insurance Ombudsman can review the decision and order a settlement. In the last quarter of 2019 there were only 50 disputes for insurance claims so it seems that the industry does the right thing to a large degree.
Independent Assessor
A functionary called the independent assessor can review the Ombudsmans’s decision they are there to make sure that there is no bias and if something seems unfair they will definitely give an objective opinion.
Litigation
Finally if none of the steps above give you a satisfactory outcome you still have the possibility of litigation and this is where the wording is going to be in your favour. In a court of law it is going to be far easier to make the claim that you had no reasonable way of knowing about your condition than you are you are of proving that it didn’t exist. To prove something didn’t exist will require expert witnesses and will certainly increase the expenses, if you have the funds to mount such a defense you are still not guaranteed to win which could also mean paying the other sides legal fees. OMG I don’t even want to think about it. So the best thing to do is to tip the scales in your favour from the very beginning. Use a product that has UK policy wording and the protection of the UK government regulation.
So leave it down to fate or give yourself the best fighting chance you can to get what you paid for.
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