Insurance firms play hard to get

NOT FORTHCOMING: They will happily take your premium, but also find every reason they can not to compensate your medical costs

By Wang Hsiao-wen  /  STAFF REPORTER

Mon, Nov 22, 2004 - Page 4

Seven-year-old Sheng Chao-zen (沈昭仁) is stricken with lymphoma.

As if this tragedy was not enough for his family, they are now involved in a David and Goliath struggle against the insurance giant, Cathay Life Insurance Corp (國泰人壽), which is unwilling to repay Chao-zen's medical costs.

Since April last year, the Sheng family paid an insurance premium of NT$80,000 for the then-healthy boy. Seven months later, Chao-zen was diagnosed with lymphoma. The Shengs spent about NT$1 million in attempting to halt the cancer's spread in the child's body. When they asked Cathay Life to recompense them, however, they were indicted for insurance fraud.

"They said that we insured Chao-zen when he was already sick," said the boy's sister, Sheng Hui-yi (沈惠宜). The child did suffer from a leg fracture after stumbling over a rock in February last year, two months before his parents signed the insurance paper. "But how is a broken bone related to lymphoma with nine months in between? This is a flimsy excuse," Sheng Hui-yi said.

Now Hui-yi takes her little brother to hospital once a week, paying about NT$1,000 for a CT scan and NT$3,000 for a bone marrow biopsy whenever necessary. The huge medical expense may soon bankrupt the family, she said.

Chao-zen is only one of some 19,652 cases referred to the Chou Ta-kuan Cultural and Educational Foundation for the Concern of Human Life (周大觀文教基金會).

During the past two years, the foundation has been flooded with complaint calls from ailing children's families who felt duped by insurance companies. According to the foundation's analysis, 35 percent of the ailing children eligible for compensation miss the two-year time frame to apply because the families are not well-informed at the time of signing the insurance contract. Some 62 percent of the families are either refused by their insurance companies or forced to put their request on hold for a bewilderingly array of pretexts.

The foundation's data shows that only a paltry 3 percent of the total cases succeed in gaining compensation, though only after these families also sign an agreement with their insurance companies to rule out further compensation.

"The insurance companies had all kinds of strategies at their disposal to make things difficult for the families," said the foundation's vice chief executive Sun Hsin-yi (孫心怡).

For instance, Sun said, the companies persist in asking for more medical records than are needed in an effort to deter their customers from making claims.

"An ordinary family stands little chance of outwitting an insurance corporation backed by an army of lawyers," said the foundation's president Kuo Yin-lan (郭盈蘭).