Accident Claim Temporary Total Disability Claim Case1

Background

The Insured’s critical illness benefit claim due to Stroke was approved by the Insurer and her policy was then terminated.

Subsequently, the Insured was involved in an accident and submitted a temporary disablement claim under the accident benefit of the same policy.

The Insurer repudiated the claim on the ground that the accident rider has been terminated upon admission of claim under the critical illness benefit.

Investigation and Findings

The following findings were noted:-

1. The last quarterly premium paid by the Insured was on 3/3/2017, thus the policy premium was paid up to 5/6/2017 when the policy was terminated.

2. The Insured met with an accident on 16/2/2017. Hence, her policy was still in-force at the time the accident occurred.

3. The Insured disability period was from 17/02/2017 – 1/10/2017, i.e. for 32 weeks.

4. The Insurer should consider paying for the Insured’s period of disablement up to the end of the full policy year’s premium collected, i.e. 5/6/2017.

Settlement

The Insurer agreed to pay the disablement period up to the end of the full policy year.