Raju was admitted to Institut Kanser Negara due to \u2018Superobese with Metabolic Syndrome, Mechanical Issues and Cholelithiasis\u2019. He made a claim under Daily Hospital Income and Surgical Benefits.<\/p>\n\n\n\n
The insurer repudiated the claim because the hospitalisation falls under the policy provision of the 30-day waiting period, Specified Illness, and treatment for weight loss.<\/p>\n\n\n\n
FINDINGS<\/strong><\/p>\n\n\n\n According to the medical report, Raju visited the Bariatric Clinic for the diagnosis of \u2018Superobesity with metabolic syndrome and mechanical issues\u2019, which were initially diagnosed during the 30-day waiting period. During his hospitalisation, an ultrasound of the hepatobiliary system revealed Raju\u2019s Cholelithiasis condition or gallstones.<\/p>\n\n\n\n We note that Raju\u2019s condition of \u2018Superobese with metabolic syndrome and mechanical issues\u2019 was first diagnosed during the 30-day waiting period. However, his gallstone condition was discovered later, after the 30-day waiting period and the 120-day specified illness clause. Moreover, the treating doctor did not indicate that the cholelithiasis is related to Raju\u2019s superobese condition; instead, it was discovered incidentally during the investigations.<\/p>\n\n\n\n OUTCOME<\/strong><\/p>\n\n\n\n Considering all factors, we recommended the insurer consider paying the claim to Raju on a prorated basis for the Cholelithiasis condition, which they agreed to, and the matter was settled amicably.<\/p>\n\n\n\n <\/p>\n","protected":false},"excerpt":{"rendered":" Raju was admitted to Institut Kanser Negara due to \u2018Superobese with Metabolic Syndrome, Mechanical Issues and Cholelithiasis\u2019. He made a claim under Daily Hospital Income and Surgical Benefits. The insurer repudiated the claim because the hospitalisation falls under the policy provision of the 30-day waiting period, Specified Illness, and treatment for weight loss. FINDINGS According […]<\/p>\n","protected":false},"author":1,"featured_media":5414,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[25,27],"tags":[],"class_list":["post-5594","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-studies","category-insurance-takaful"],"acf":[],"yoast_head":"\n