Private health insurers often reject damage notifications on the grounds of "pre-existing disease" or "policy exception".
Typical Reasons for Refusal
- Pre-existing disease
- Insufficient declaration (input questionnaire)
- Waiting period not expired
- Aesthetic treatment
- Birth (covered under the policy not)
Objection Ways
- Written objection to the insurer + additional medical report
- Insurance Arbitration Commission
- Consumer arbitration committee / court
- Commercial court of first instance
Declaration Obligation
- All diseases must be reported at the contract stage
- Deliberate concealment: contract cancellation reason
- Not knowing: disputed (Supreme Court in favor of the insured)
Supreme Court 11. HD
11. HD accepts that the insurer must prove the claim of "pre-existing disease" with "concrete medical evidence", and that a mere claim is insufficient.
Emergency
In cases requiring urgent intervention, the insurer must generally cover the treatment immediately at the contracted hospital.
Practical Tips
- Report all diseases before the policy
- Call the insurance before treatment. get pre-approved
- Keep all reports/invoices
Insurance/consumer attorney recommended.