Revised quote on wrong medical reports

POSTED BY Mihir Shah ON June 22, 2011 2:32 pm COMMENTS (10)

I have recently made a proposal for Kotak PTP for 65L. All the formalities have been completed including medicals. It’s been a month now and just yesterday I got a mail from them about the revised quote due to “Elevated Nicotine Level”. This comes as a shock to me as I have not been engaged in smoking habit till now. I had also not taken Tea or Coffee as suggested by my adviser. Now they have revised the quote based on medical reports and increased the prem to 4K extra. Is there a way I can prove those medical reports wrong? What options are available to me in such a situation?

10 replies on this article “Revised quote on wrong medical reports”

  1. This is full of info and knowledge 🙂

    Manish

  2. Dhawal Sharma says:

    @Manish/Mihir – Wanted to share the REAL-LIFE experience of the same topic of discussion as above..I met with one of my client about 2 weeks back for a TERM PLAN for 50 lakhs..He was interested in taking up a sum assured of 1 crore but he decided to split up in 2 policies, one from KOTAK and another from ICICI PRUDENTIAL..So he invited me for documantary formalities etc to his place on 12th JUNE..At the same time, ICICI PRUDENTIAL guy was also there, collecting documents and filling up forms..Both of us filled our respective forms, collected the cheques and went away..Medical tests for the client, both from KOTAK as well as ICICI were done on 26th JUNE and 25th JUNE respectively..Now, today he has got SMS from KOTAK regarding LOADING in his case because of ELEVATED NICOTIN LEVEL..At the same time, his policy from ICICI PRUDENTIAL is issued today..

    He raised the same query like Mr MIHIR has done in this thread..Now further explanation I got from the company is
    * Firstly, ELEVATED NICOTIN LEVEL is also because of usage of TEA & COFFEE over a prolonged period of time, and nothing to do with being NON-SMOKER.
    * Secondly, different companies have different takes on RISK PROFILE issue of the proposer. Say for example, lets suppose my client’s ELEVATED NICOTIN LEVEL is 45 (and lets suppose the normal range of NICOTIN LEVEL is 30-40), Then this elevated level of 5 points CAN BE taken as SIGNIFICANT by one company and might be taken as INSIGNIFICANT by another company..as in case of my client, his elevated level might have been taken by ICICI PRUDENTIAL as insignificant and hence his policy got issued from them but whereas in our case (KOTAK), he is required to pay LOADING..

    Hope this will help further to understand the issue..

  3. sainath says:

    “.But the only point of concern from my side is what will you do if the medical tests done for other company too showed your NICOTIN LEVEL to be high??”

    What if other medical report show NICTON LEVEL to be low? Can Kotak be sued?

    1. Dhawal Sharma says:

      @SAINATH – Dont know but do give it a TRY 😉

      Never seen anybody SUING the company for such issues..So next time if you SUE kotak or any INSURANCE COMPANY, do let me know what was the outcome..

  4. Dhawal Sharma says:

    Hi MIHIR/MANISH,

    First things first, it takes around 30 to 40 days for a TERM PLAN of higher SUM ASSURED (> 50 lakh or so) to get issued..So nothing to worry about on the TIME LINE front..

    now for ELEVATED NICOTIN LEVELs, it depends upon a number of factors..There is usually a range which is specified as NORMAL, say for eg 30-40..If the NICOTIN LEVEL during medical tests comes out to be 41 or above, it will be labelled as ELEVATED even though its very insignificant proportion..As such, you should not take it as a SHOCKING NEWS..Secondly, as you have mentioned you dont smoke NOW but have you ever smoked in your life or in the past, say about 9-10 months back?? If that is the case, it is found that PAST SMOKERS or PASSIVE SMOKERS (The ones who do not smoke but sit in the company of smokers) tend to have elevated NICOTIN LEVEL..If you had not taken tea or coffee on the day of medical test, that will not reduce/diminish/erase already present NICOTIN LEVEL, which turns out to be HIGH according to the company..

    Medical reports are not manipulative, they are the facts provided by the labs to the company and company is taking decision on the basis of the labs report, thats all..In the CONSENT LETTER, company usually provides the value found on medical tests..There is no point proving them right or wrong..

    Yes, you can take remedial actions by refusing to accept the LOADING TERMS and LOADED PREMIUM and the company will return your PREMIUM AMOUNT by deducting the medical test charges..And if you are so sure that your NICOTIN LEVEL is within limits or will be in normal range, you can withdraw your application from KOTAK and apply in some other company like LIC or ICICI PRUDENTIAL, or HDFC LIFE etc..But the only point of concern from my side is what will you do if the medical tests done for other company too showed your NICOTIN LEVEL to be high??

    1. Ramesh says:

      Thanks for the nice info.

    2. Thanks for the reply Dhawal . It was nice info to know 🙂

      Manish

    3. Mihir Shah says:

      First of all let me thank you all for your replies. It really helped. Few thought still hunting my mind though. To dear Mr. Dhaval..I am trying to digest that it may take 30-40 days time to process a policy above 50 L as you said..Its hard to believe why it takes so much of time just to read the medical report which suggests the elevated nicotine level in it. One of my collegue who has taken 45L term insurance from the same company provided his policy withing 15 days. Does extra 15 L took editional 15 days time? I agree that if there are any more details required after going through your medical reports would take some time but if something noticeable found on your medical report at the first glance then it can be intimated without delay. Anyways that’s not my main issues to deal with.

      As I mentioned in my post earlier that I have never ever consume tobacco or smoke in my life and also not been in a circle of people who smoke regularly. I am also not sure how regular daily one cup of tea can induce Elevated Level of Nicotine. If that the case then more than 70% of indian population will be covered under advance nicotine level. Is that the right reason of having above average nicotine level?

      I am not saying that the report is fake but at the same time I can not eliminate the slightest chance of mistake in the report. We are human and prone to err..I am just having a doubt and that’s the reason I have asked Kotak to re-examine. If Kotak or any other insurance company for that matter consider a medical test (nicotine) done from any other lab outside their network a valid one then I am even ready to do that but I am not sure they would count it.

      You asked me what if I undergo re-examination or do a medical test for another insurance company and found the same nicotine level.. to that my answer would be..I will pay the extra load to the prem and accept the policy. But what if I found it the otherway? Why is that we have to rely upon the medical examiniation done by the insurance company? Why we need to think that there will not be any chance of human error in that?

      To be honest I am not completely agree with your reply..still some level of transparency is required. I like to mention one more thing that I am not against Kotak, in fact I have taken a term plan for my wife a year ago and I don’t have any issue till now..I consider this plan after some research and noway I am blamming company here.

      1. Dhawal Sharma says:

        @MIHIR – Hello Dear..I was out of town so could not check your response earlier..

        Let me begain by telling you that around 30 days time for a TERM PLAN of big SUM ASSURED has many aspect to it, and not only MEDICAL ASPECT..It also includes FINANCIAL UNDERWRITING (Where the proposer has submitted his FINANCIALs, like last 3 years ITR or last 6 months BANK STATEMENT and FINANCIAL QUESTIONNAIRE)..So the time taken for issuance of such a policy is a BIT MORE than compared to ULIP or MONEYBACK or TRADITIONAL policies..

        Again, let me stress the point that consuming TEA on a regular basis is not the ONLY reason for elevated nicotin level and elevated is again subjected to different meanings to different people..Above the range can be okay for us mortals but can be high or unreasonable for company offering such huge SUM ASSURED..

        One more PSYCHOLOGICAL obeservation on my part 🙂
        “MEN BELIEVES IN WHAT HE WANTS TO BELIEVE.” Actually we are PROGRAMMED in such a way that we suspect HUMAN ERROR or some MISTAKE the moment there is slight deviation from the normal/routine..You are doubting the medical report because it comes out to be something else than what you have expected..Would you have still forwarded the same logic (THERE MIGHT BE A SLIGHT HINT OF HUMAN ERROR) if the report would have come out normal??

        I am not at all taking side of my company..I am just letting you know that what could have happened..

  5. Dhawal Sharma will be able to answer this with better accuracy and info , let me drag him here ! . Wait for some time and come back in 1-2 days

    Manish

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