Covid-19 and Insurance Claims Disagreements

In a world experiencing a global pandemic from the Covid-19 Coronavirus, nothing is as simple as it once was. From businesses having to create and implement “work-from-home” contingencies and operational continuity, to individuals trying to figure out how to best provide for their families in a climate of uncertainty, by this point it should be clear that the Covid-19 pandemic is going to fundamentally change all aspects of life in the 21st century.

Insurance is definitely an area that has the potential to be impacted by the Coronavirus. In recent months we’ve explored some of the potential interactions between insurance and the virus, and what these could mean for you:

• Employee’s Compensation while working from home.
• The Coronavirus and Life Insurance Exclusions.
• Increased Cyber-crime because of the virus.
• Employee’s Compensation for catching the virus at work.
• Health Insurance Portability and Continuation.
• Customers claiming your business gave them the virus.

Each of these topics and forms of coverage will be handled in a different manner, and have different types of coverage involved (more information on each of these cases can be obtained by clicking the link), but outside of specific, named exclusions, most insurance claims that may occur in relation to the Covid-19 Coronavirus pandemic will be predicated on the assumption that the insurer will accept it.

But what if the insurance company doesn’t accept the claim? What if it is a claim that, you feel, should be honored under the insurance policy?

Dealing with the fallout from the Pandemic is stressful enough without worrying whether your insurance coverage is there to protect you when you need it.

Your Covid-19 insurance claim is submitted, now what?

Are there any exclusions?

The first thing to consider when submitting any insurance claim is whether there are any exclusions present on your policy which would prevent the claim from being honored.

For claims that have been submitted due to the Covid-19 Coronavirus pandemic, the first thing to look for is whether there are any Pandemic, General Health Crisis, or Pathogen exclusions present in the policy wording for your specific plan.

For example under many event insurance products, claims that have arisen due to a health crisis or disease are generally excluded from cover. While this exclusion can be clawed back (or removed) in exchange for a higher premium most event insurance products will have a blanket exclusion for situations like the Covid-19 Coronavirus pandemic; meaning that any claim you submit which can be tied to the virus or pandemic will be denied under these plans.

Any insurance plan where there is a Pandemic, General Health Crisis, or Pathogen exclusion will likely not honor claims submitted where the proximate cause of the claim is the Coronavirus. Under our event insurance example, if an event (like a concert) is cancelled because of restricted movement due to the coronavirus, and the pandemic exclusion is in place, no claims will be paid for the cancelled event.

If no exclusions exist, do I have cover?

It would not be unreasonable to assume that, if your insurance plan has no specific exclusion for Pandemics or other health crises then you should be covered; correct? Unfortunately, the situation is more complicated than this especially depending on the type of insurance protection you have and are trying to claim for.

Under an Employees’ Compensation Insurance policy, for instance, just because the plan may not specifically exclude Covid-19 or other pandemics from coverage does not mean that claims in relation to such a situation would be admitted. EC Insurance is a tricky one, because it is regulated by the government and is designed to protect employer’s liability towards workers should they suffer an accident or occupational disease through the routine course of their employment.

This is important because not all diseases can be covered – the Employees’ Compensation Ordinance specifies a list of occupational diseases that are covered under Employees’ Compensation insurance and it is these maladies that are claimable through the insurance.

However, the very nature of Covid-19 means that it is extremely possible that a worker could catch the virus through the normal course of their employment which would technically make the illness fall under the umbrella of EC Insurance protection.

My claim was rejected even though there is no exclusion

Whether its Health Insurance, Business Insurance, or even General Insurance, there is the strong possibility that you have submitted a claim (or will be submitting an insurance claim) that is connected to the Covid-19 pandemic.

There is no exclusion on the policy, so you assume that you’re covered, but then the insurance company tells you that they will not be honoring the claim. What can you do?

If you are a CCW Global customer then you are able to contact you broker to discuss what options are available to try and get the claim paid. CCW Global insurance brokers have an expert understanding of the products we work with and levels of access to the insurance companies which are unavailable to members of the general public. If a claim looks like it should be covered according to the policy terms and conditions and no exclusions are applicable, then CCW Global will work with you and the insurer in order to get the claim settled.

These are known as “grey area” claims, and occur outside of the Covid-19 pandemic situation. However, the current pandemic has seen a significant increase in the number of “grey area” claims being experienced, which is understandable in light of the mass confusion caused by the virus. Despite this, policyholders have a right to the coverage which they have purchased; CCW Global works on your behlaf to ensure that this coverage is provided.

I’m not a CCW Global Customer. How can I get my claim settled?

If you are not a CCW Global client your option for dealing with a claim that you feel should have been settled, but which was in fact rejected, is to start a legal challenge. With claims related to the Covid-19 Coronavirus pandemic there is the very real chance that the resolution will only occur after many years in court.

This is simply because there are so many different types of insurance impacted by the virus, and there are so many scenarios which have not specifically been accounted for when it comes to offering insurance in the pandemic. With the exception of a very limited number of highly specific insurance policies, the majority of plans either exclude or do not specifically say whether claims in relation to the virus are covered. This creates an environment rife with confusion, uncertainty, and the need for clear definitions and standards; hence the legal challenges, some of which are to commence by the end of the year.

The nature of the virus itself poses a major problem when it comes to many different types of insurance. Health Insurance, which covers the cost of your treatment for an illness or injury, is probably the easiest product to understand in relation to the pandemic. Other types of insurance, Employee’s Compensation and Public Liability, require far more intangible connections to the disease and more creative coverage definitions before claims are likely to be settled. How does a worker or customer prove that they caught the virus under the definition of the insurance offering protection?

Its hard enough for national governments to identify and stem the tide of the pandemic, requiring strict social distancing and stay at home orders to effect any meaningful impact on the virus. Asking an individual or business to prove that a specific entity gave them Covid-19 (which is a very real outcome of a legal case) months after the illness will be a very difficult challenge.

All of this is to say that there is here, as elsewhere when it comes to the Coronavirus, a great degree of uncertainty. It is inevitable that we will see legal challenges to the coverage provided by the insurers for claims related to Covid-19; across all product and customer types. This is the final option for customers who feel like their claim has not been properly handled by the insurers in this time of crisis and will undoubtedly happen.

Free Hong Kong Insurance Consultations

If you would like to receive a free, no-risk, no-obligation consultation about your insurance during the Covid-19 Coronavirus pandemic, or if you would like to enquire about obtaining coverage to protect yourself, your loved ones, or your business at this time, please Contact Us Today.

Our expert Hong Kong Insurance brokers are able to advise on a wide range of insurance coverage and give you unbiased insight into the impact of the coronavirus on most forms of coverage.

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