Question by : Outdated disease definition in insurance policy?
According to a certain insurance policy, “heart attack” is defined as such that is quite obsolete in current modern medicine. Now, a person is insured for a critical disease, heart attack. His medical reports state heart attack as the causal factor. The descriptions agree to current global definition of heart attack but not as what stated in the insurance policy. So, the insurance company refuses his claim.
From legal aspects, how should I argue (in an appeal letter) that the insurance policy should accept the “new” heart attack definition (as put forward by the Joint ESC/ACCF/AHA/WHF Task Force, published in European Heart Journal) since it is more accurate than the policy’s obsolete one?
Best answer:
Answer by mbrcatz
You might be attacking this the wrong way.
Have there been any ENDORSEMENTS on the policy, in the meantime, to update the language to modern terms? You need to check that, first.
You ALSO probably need to get a doctor to write a letter, explaining that the language in the policy is obsolete (how OLD is that policy, anyway?), and that the current definition of heart attack is blah blah blah.
In other words, you’ll need a medical expert to look at the wording in the policy, the current accepted wording, and tie them together for you.
Know better? Leave your own answer in the comments!
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