Kathmandu. Many people think that the work of an insurance agent is limited to the sale of insurance policies. However, the real responsibility for an experienced agent begins during the time of insurance service and claims.
An insurance consultant who has been working in the insurance sector for 17 years shared his experience and said that a few years ago, one of his clients was diagnosed with brain tumour and the hospital expenses during the treatment were more than Rs 25 lakh. However, the insurance company rejected the claim saying that it did not provide information about hypertension. The company claims that high blood pressure was the main cause of the disease.
In general, many agents consider that their duty has been fulfilled by communicating the company’s decision to the client. However, the experienced agent did not accept the company’s decision easily. He consulted doctors, studied the medical reports minutely and finally had discussions with experienced senior specialists. He also consulted with experienced former employees involved in investigating claims for other insurance companies.
The medical findings that followed undermined the insurance company’s argument. The claim was revived on behalf of the insured with new evidence, expert opinion and necessary documentation after experts said there was no direct link between the affected brain and high blood pressure. The agents took the initiative on behalf of the insured side by taking the documents from the insurance regulator. Finally, after a review, the insurance company had to reconsider the claim and pay Rs 23 lakh.
According to the agent, insurance is not just an economic product, but a guarantee of support in times of crisis. “In a hospital, a person living in a state of fear and stress needs not only paperwork but also a helping hand to stand up and fight back and provide moral support,” the agent said.
Therefore, advising the business agents and the insured parties who have rejected the claim, the agent says, “The insurance company should not be disappointed if the claim is rejected.” Justice can be restored if the right initiative is taken, along with additional evidence, expert advice, and a close study of some legal provisions. ’
