Repudiation of Insurance Claim Payment

In February 2014 the consumer formally becomes an insurance policy holder after making the first payment on December 19, 2013. Before the customer joins the insurance programme, his four family members consisting of his wife and three children had already become insurance policy holders at the same insurance company. In early 2016 consumers filed claims which received by insurance companies on February 4, 2016. Claims are filed in the form of hospital and surgical cover and early stage crisis cover over consumer health care. But for no apparent reason, the insurer rejected the claim and even canceled the policy benefits for two of consumer’s children.

Based on the complaints made by consumers, the initial review of the case was performed, especially related to consumer rights on the benefits as policyholders. The results of the study then used as the basis for invoking against the insurance company that issued the policy.

At the first meeting, the insurance company is asked to explain the acceptable benefits of the policyholder and the results of the meeting was  decided that the insurance company will conduct a reassessment of the risks borne by the company.

The first meeting was followed up by the second meeting, after which the insurance company has performed reassessment on the risks of the consumers, based on the latest medical history, the consumer would eventually become the right to the policy due to the initial payment of the 235 million rupiah for covering crisis stage and the hospital operation benefits of 2 million per day. Moreover, the insurance policy of his two children were also reactivated.