Brokerfish

Fraudulent Claims in Insurance Policy

What Happens in the Event of a Fraudulent Claim

It is important that the information you and your dependants provide, such as on the Application Form or supporting documents, is accurate and complete. Failing to provide correct information or not disclosing material facts that may affect our underwriting decision can result in your policy being invalidated from the start date. Additionally, you must inform us of any medical conditions that arise between completing the Application Form and the policy’s start date. Such conditions that are not disclosed are likely not to be covered. If you have any doubts about the relevance of certain information to underwriting, please do not hesitate to contact us for clarification.

If the policy is rendered void due to incorrect disclosure or non-disclosure of material facts, the premium paid to date, minus the cost of any medical claims already paid, will be refunded. However, if the cost of claims exceeds the balance of the premium, the principal member will be responsible for the reimbursement.

Insurers will typically not provide benefits for a claim if:

The claim is false, fraudulent, or intentionally exaggerated.

You, your dependants, or anyone acting on your or their behalf use fraudulent means to obtain benefits under a policy.

In the event of a fraudulent claim, any benefits paid before the fraudulent act or omission was discovered will become immediately owed to the insurance company. The premium paid for the policy will not be refunded, in part or in whole, and any pending claims settlements will also be forfeited. The policy will be cancelled from the date of the discovery of the fraudulent event. It is important to provide accurate and complete information when applying for IPMI coverage and to immediately inform the insurance company of any changes or new medical conditions that may arise. Failure to do so may result in a void contract and a loss of benefits.