Insurer overly cautious in risk assessment

Insurer overly cautious in risk assessment

I agree with the comment by Dr Lam Pin Min, chairman of the Government Parliamentary Committee for Health, that there is a perception that "many insurance underwriters are overly cautious to the extent of being unfair or unreasonable in their risk assessment" ("MOH asks insurer not to reduce payouts"; Dec 16).

I go for a mammogram every year. Although a cyst in my right breast was detected, it has been deemed benign and I have been advised to go for a follow-up every year.

My doctor said the cyst was likely to be a water cyst and there was nothing to be alarmed about.

Last year, I bought a Shield plan from Great Eastern Life and told the agent about my yearly mammogram.

He asked if there was any problem and I told him my doctor's verdict that there was no issue. The agent also declined my offer to provide the doctor's latest report.

During a review of my plan with the agent earlier this year, I was told that the insurer had concerns despite my doctor's assessment. The agent explained that the insurer wanted to protect its interest.

Now, it wants to exclude coverage for any treatment arising from growths, lesions and cysts on both breasts, despite the mammogram not finding anything abnormal with my left breast.

I wonder if the insurer has an overly conservative approach to risk assessment.

My doctor told me I was not the only one in such a predicament, and that she has seen a lot of such cases.

It would be good if there was some alignment between insurance risk assessments and medical assessments, and if there was an independent body to provide a fair assessment in disputed cases.

Escee Lam Sook Ching (Madam)

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