I have sent an email to OHRA insurance about this matter, see below:
I entered Thailand on November 13, 2020 with a standard Statement of Insurance. In the meantime, the Thai Embassy in The Hague decided sometime in December 2020 to no longer accept this Statement because it does not expressly state the cover amounts desired by the Thai government.
These are for inpatient (hospitalization) 400.000 baht (approx. 11.000 euros) and outpatient (outpatient treatment) 40.000 baht (approx. 1.100 euros), as well as coverage against Covid-19 of USD 100.000.
The Thai embassy in The Hague is well aware of the operation and coverage of Dutch health insurance, basic and supplementary, and therefore knows that our coverage is many times better. However, they have had constant problems with Thai immigration in Bangkok, which is not aware and insists on seeing the amounts prescribed by the Thai government on policies or statements.
Before I left I requested a quote for the desired cover from a Thai insurance company, Pacific Health Cross Insurance, because I was not sure at that time whether my Statement would be accepted.
The cover for the inpatient-outpatient for 7 months would cost me 31.000 baht 850 euros or so and the cover for Covid-19 36.000 baht for the same period, about 1.000 euros. Now I was still happy that she wanted to insure me because I later learned that many older people become hibernators and were refused on medical grounds.
It is absurd that we Dutch people have to take out double insurance, if that is even possible, while we are much better insured. We pay a fairly hefty premium for this insurance. And that's only because the companies categorically refuse to state amounts while they run no risk because the coverage of the policies is much better than the amounts requested.
I would therefore ask you to bring this matter before your management or an umbrella body that has the power to change something about this situation.
I will certainly deal with this in the future.
Regards.
I also sent the same email to the VVD party in the House of Representatives with the following accompanying text:
Today I have sent the story below to my health insurer, namely OHRA health insurance.
I ask your attention to this problem, in short, it is expensive and often impossible for Dutch people with a Dutch health insurance basic and supplementary to spend the winter in Thailand. At least one has to take out double insurance at high costs as you can read, but what is worse, often the elderly cannot even take out insurance due to their health condition.
That is why I am also turning to your group, although until now exclusively to your group.
I hope to hear positive from you soon.
———————————–
Submitted by Theo
Number of times read: 135
42 Responses to “Reader Submission: Rejecting Statements of Insurance”
Jannus says up
18 January 2021 at 08: 32
Since the VVD is more of the business community, it seems to me that parties such as the SP or 50Plus are more appropriate to be approached. Nevertheless, it is actually a task of the Thai Embassy to properly inform Immigration in their home country about the Dutch healthcare system.
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RonnyLatYa says up
18 January 2021 at 09: 46
Not agreed. An embassy should not do that.
Applicants want to go to Thailand and they must meet the conditions that Thailand imposes in this case.
It is not the job of Thailand/immigration to know how health care is arranged in each country. Just like the Netherlands or Belgium should not know how healthcare is arranged in another country for travelers from that country.An insurance party simply has to confirm what is requested .
If you are asked to confirm that you are insured for a minimum of 40 Baht/000 Baht for a specified period of time, it is the insurance company's job to confirm or not and not come up with any other answers.How hard can that be…. ?
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Guy says up
18 January 2021 at 11: 22
Sorry, I cannot agree with that statement. In my humble opinion it is a task, even a duty, of Governments to be aware of international customs.
Thailand should therefore, among other things through its Embassies in Europe, be aware of the customs that apply in the insurance world and are generally accepted.
The European Diplomacy could intervene and point this out to the Thai Government in the context of international cooperation.
Insurance companies are autonomous (private) companies that must comply with certain rules.
Accepting the demands of a Nation is not one of them.Of course, each of you may have your own opinion on this.
regards
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Ruud NK says up
18 January 2021 at 13: 09
Guy I totally disagree with you. Thailand is the host country and as the host country Thailand can set the rules that apply to Thailand. And not only for whether or not you are insured, but for all the perhaps incomprehensible rules that Thailand demands. You should abide by that as a guest, sorry for you in the Netherlands and abroad, but that's the rules.
But maybe you can temporarily cancel your Dutch insurance for the period that you are in Thailand.Like
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ruud says up
18 January 2021 at 14: 24
It does not seem to me that it is the task of the Thai government to keep track of all the conditions of all health insurance policies of all countries in the world.
If you want to be admitted to a country, that country can decide for itself what the rules are.
A passport, a visa, maximum stay and yes, also proof that you are insured for a minimum amount for healthcare costs.
Maybe even civil liability insurance for the mess makers.It is up to the person who wants to enter the country to demonstrate that he meets all the requirements, not the government to have to investigate that.
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endorphin says up
18 January 2021 at 17: 10
Then why is there still a diplomatic post?
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RonnyLatYa says up
19 January 2021 at 01: 18
To also ensure, among other things, that the Thai laws, requirements or regulations to travel to Thailand are met or respected.
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Marc Dale says up
18 January 2021 at 16: 34
Dude, that's not right. Each country can link access to its own set rules and, through their embassies, need not worry about what is customary in all other countries in the world or what is specific to the health system or anything else. Those who want to enter the country legally must meet the requirements. Point. The country WOULD take this into account if they wanted to and therefore want to provide exceptions to it. The question is where all this can lead. The Netherlands is like this, Brazil is like that, etc. In the above case, it is the insurance companies that must provide their customers with the necessary documents if the insurance taken out meets the requested conditions
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MikeH says up
18 January 2021 at 12: 07
Dear Ronny, with all due respect for your knowledge of the visa process and your willingness to answer the same questions over and over again. but with the second part of your comment you are not right about the Dutch basic insurance (see below). Possibly because you assume the Belgian situation. Basic insurance is strictly regulated by the Dutch government. They are not free to name amounts. This requires a change in the regulations.
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RonnyLatYa says up
18 January 2021 at 12: 27
And then Thailand should adapt to that?
The Netherlands could also adapt. And they don't want that. Then bad luck for the Dutchman, but that is not the problem of Thailand.
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MikeH says up
18 January 2021 at 14: 22
No, Thailand does not have to adapt as a host country. It's up to them to make demands and it's up to us to meet them. The only thing I am saying is that it is not the unwillingness of the insurance companies, but the strict Dutch regulations. Not Thailand's problem indeed
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RonnyLatYa says up
19 January 2021 at 01: 19
“And then Thailand should adapt to that?” was meant more rhetorically. 😉
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Bert says up
18 January 2021 at 17: 39
Why can't they do that?
I think they are more afraid that the bill will be equal to the requirements and therefore they do not put any amounts on the statement. But this is just my take on that squabble.Insured are all necessary medical costs, including COVID-19 treatment and necessary
observation, which could not be foreseen at departure, during a temporary stay abroad for a
period of at most 365 daysThis sentence is in my statement from Unive.
May hope that that is sufficient if I can / can travel in April.Like
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GER says up
18 January 2021 at 22: 53
no this was not sufficient with my visa application September 2019 visa application was refused I also had a travel insurance policy with health insurance and my health insurance policy in English
I had to take out Thai insurance first
but I don't know if you already have a visa that mine had expired.Like
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khaki says up
18 January 2021 at 12: 26
My Thai wife will especially like that if I stayed at home. Many of us have already entered into obligations in Thailand (e.g. marriage, investments such as a home, savings in a Thai bank, etc…) that cannot simply be reversed. Or do you think we should just take our loss (however personal), stop whining and go to Costa Rica, Greece or another hot country next year???? Unbelievable your reaction.
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khaki says up
18 January 2021 at 13: 22
Dear Ronnie,
For the first time I disagree with you, unless the Thai government only requires insurance from Thai companies. And I think that's not the case. On the other hand, they even set very reasonable conditions in principle, namely insurance policies with only relatively very low sums insured, often insufficient for complete care and cure for more serious illnesses.
However, it also seems to me that it is the task of an embassy to take some account of the culture and customs (read: insurance facts) of the country in question where they have to represent their Thailand. NL simply has a statutory health insurance obligation, which already goes very far, especially when compared to Thai insurance standards. It is also undeniable that our health insurance policies are much better and more complete than the Thai ones. This probably applies to the Belgian insurance market as well as to the Dutch one.
And then the embassy will also have to take this into account and convey this to its government.
The strange thing about this whole spectacle is the unpredictability that the embassy shows. Sometimes they reject the insurance statements, but sometimes I also read here that a statement (without mentioning amounts) has been accepted. From this I conclude that it is not an actual measure imposed by BKK.Like
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RonnyLatYa says up
18 January 2021 at 14: 36
But Thailand does not refuse the Dutch health insurance(s) in itself. They think that health insurance is quite ok. That's not the point at all.
They only want to see the minimum amounts confirmed in Thailand.
And apparently those insurance companies do not want or are allowed to mention that.
Perhaps, as you say, you should take into account the culture and customs (read: insurance facts) of that country. The same goes for the country you are going to….
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khaki says up
18 January 2021 at 15: 52
My insurer has confirmed to me in writing that they cannot name an amount because they do not apply a maximum .... which amount should you enter??? And minimum amount (if you do not take the deductible with you) is certainly not there…
And of course you take into account the culture and customs of your host country, but that is mutual, even if you are an embassy guest representing your country. And you don't do that by asking the impossible (because our insurance policies do not insure maximum amounts; they cover the diseases and their treatment).
We are already constantly dealing with that Thai insurance culture, but that does not mean that we accept it, just as the Thai apparently do not accept our policy insurance culture. But aren't we getting away from the real problem? And then we state here that it is madness to accept those Thai policies when we already have a better product ourselves. Or are we no longer allowed to propose a solution? Our policies do not harm Thai customs and culture in any way: in fact, they are an enrichment!!!!!
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RonnyLatYa says up
19 January 2021 at 01: 46
Taking a country into account does not mean that you have to adapt the requirements of your own country to that country. Should every Thai embassy adjust its visa requirements to the country where they are located?
You are only asked to confirm a minimum. And if you call that asking the impossible….
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Eddy says up
18 January 2021 at 08: 59
Hello Theo,
Thank you for your action. Many (potential) travelers to Thailand will be happy. Hopefully there will be some movement.
A little nuance from my side:
1) as long as Thailand has code orange (only strictly necessary travel) at the time of travel, no insurance taken out in NL provides compensation due to Covid to my knowledge.
So mi there is no alternative to the Covid insurance requested by Thailand.
2) I think part of the solution has to be found by the travel insurance group.
Many travel insurers already issue English statements for specific countries such as Bosnia, Russia. Allianz's statement for Russia includes “Insured amounts: .. medical expenses: no limit..”.
Source: https://www.reisverzekeringkorting.nl/blog/reisverzekering/verzekeringsverklaring-rusland/
I think it would be a small effort if they also issue a separate statement for Thailand with a slightly modified text such as “Insured amounts: … medical expenses – inpatient & outpatient: no limit..”
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Matthew says up
18 January 2021 at 11: 11
Covid-19 is always covered by basic insurance regardless of colour. From 1-1-2021 no more coverage under the additional insurance for orange and red, which means costs above the Dutch standard will not be reimbursed.
Problems can arise due to the fact that Thailand requires every Covid-19 patient to be admitted to a hospital, while there is not always a medical necessity for this.
In some cases, those people also have problems with private COVID-19 USD 100.000 insurance.Like
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MikeH says up
18 January 2021 at 11: 58
Point 1 is incorrect. You are confusing two things. The Dutch basic insurance is valid everywhere and always (including covid), regardless of the color of the country. This insurance is a curious hybrid: offered by private companies, but subject to strict government regulations. For example, they are not allowed to determine the content of the insurance themselves and they are not allowed to refuse people on the basis of medical history. They are also not allowed to mention amounts. I know many here don't believe that, but it really is. To change that, a change in government regulations is needed. I don't see that happening any time soon. I don't know how this is arranged in Belgium
On the other hand, there are additional insurance policies and travel insurance policies. Most of them are currently not valid in orange countries. That's a choice. They are not subject to the same government regulations as basic insurance. Some do offer insurance that is accepted in Thailand (Oom, for example). In practice, this indeed leads to double insurance and extra costs.
It's not the Thai embassy's fault. They accepted the statements of Dutch companies for a while, but were apparently called back by the Thai government
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endorphin says up
18 January 2021 at 17: 31
Then it seems to me an assignment for the Dutch and Belgian embassies to raise this with the Thai government, and point them to the more extensive insurance policies in this regard. The embassies represent our countries in that third country (Thailand).
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Sjoerd says up
18 January 2021 at 12: 46
My FIC (Foreign Insurance Certificate) also said “unlimited” and that was accepted (circle essential words on some documents to make things easy for the Thai Embassy and Immigration in BKK).
I think your health insurance always applies, even with code orange.
https://www.zorgverzekeringslijn.nl/nieuws/op-vakantie-naar-een-geel-of-oranje-gebied-wat-betekent-dat-voor-de-dekking-van-mijn-zorgverzekering/
“Staying in a country with a negative travel advice in connection with corona does not fall under those exclusions”https://www.zorgwijzer.nl/zorgverzekering-2021/dit-vergoedt-je-zorgverzekering-bij-corona
“In countries with code orange or red, you are reimbursed for emergency care through your basic insurance, but usually not through your additional insurance or travel insurance.”https://www.zilverenkruis.nl/consumenten/magazine/corona-informatie/veelgestelde-vragen/vragen-over-coronavirus-en-het-buitenland
“We reimburse according to the normal conditions of the basic insurance and supplementary insurance. You do pay your own risk. View the reimbursement for urgent care abroad.”An ordinary travel insurer can refuse payment for damage, for example the costs of repatriation.
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wim says up
18 January 2021 at 09: 05
From writing I understand that the problem is not with the Thai Embassy but with MFA in BKK. So it seems to me that there is a role for the NL Embassy in BKK to smooth out these kinds of unnecessary wrinkles.
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Ralph says up
18 January 2021 at 11: 59
dear Theo
Thank you very much for the effort you have made.
I suppose many people have had to deal with the often stoic attitude of insurance companies.
I hope that we will soon get a definite answer from politicians or insurance companies themselves.
Thanks again and I assume many with me.
Ralph
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PEER says up
18 January 2021 at 14: 07
Dear Ralph,
We know all too well that these insurance companies are part of large existing insurance giants!
It's pocket-pocket.
So why will they do this.
I am insured with CZ.
In addition, a continuous travel insurance with Van Lanschot Chabot.
Both refused to mention the specific amounts, so the undersigned had to take out an extra travel insurance policy!
But I'm here!Like
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khaki says up
18 January 2021 at 12: 12
Theo!!!! Chapeau, finally an ally who also rings the bell!!! I just came back from the district office of CZ (my health insurer), because I don't let it go by that our basic insurance policies, which are also not cheap (but, compared to "other" policies, you also get something for that!! !!.), are largely swept off the table!!!
I do, however, point out to the bloggers that, now that I am becoming more familiar with the subject matter, additional insurance is almost always required on top of the basic insurance (which my policy covers 70% abroad) to cover (in my CZ case) full insurance. 100% coverage abroad!
Hopefully we will keep each other informed through this blog.
Khaki
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Ger Korat says up
18 January 2021 at 23: 27
How is this possible, if you have basic insurance with CZ then you are insured for almost everything abroad as you are insured in the Netherlands. In addition, you can take out physiotherapy or dentistry for the extra costs, which are not included in the basic package. All details regarding the basic insurance can simply be viewed with every insurer because that is a standard. If you claim that your policy reimburses 70%, then you also state facts, I also have a CZ policy. My only supplementary insurance with CZ costs me 1 Euro per month and then I am covered for emergency assistance abroad as well as medically necessary repatriation from abroad as well as emergency dental care abroad for a maximum of 275 Euro. Yes, all that for 1 Euro per month, and also insured for the same as for which I am also insured in the Netherlands thanks to the basic insurance. Now tell me what CZ was trying to sell you on and what I don't think is necessary.
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Hans van Mourik says up
18 January 2021 at 12: 26
Very good Theo for doing this.
Even if it's just to make your voice heard, which you disagree with.
While it is only a small effort for the insurance company to write this down, the amount.
Perhaps you can also send the same message to the Dutch Ombudsman (female).
Do know that all Dutch people living abroad also did this many years ago, but then the ZKV Universal policy with the country of residence outside Europe (signed jointly by 1 man).
With the question why the insurance is so expensive.
The answer was then, because this insurance is a private insurance, the National Ombudsman (female) can not do anything about it, am not obliged to take it.
Hans van Mourik
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Joop says up
18 January 2021 at 12: 45
It is disappointing that the Thai government is so rigid, while people there (whether or not through their own embassy) should know better.
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RonnyLatYa says up
18 January 2021 at 14: 38
You can also say that about the Dutch government and their insurance regulations.
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RonnyLatYa says up
18 January 2021 at 14: 40
Allowing people to state the requested amounts, and everything is resolved.
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MikeH says up
18 January 2021 at 15: 16
Precisely. If the Dutch regulator would allow this, the problem would be solved. No law change or major changes are required, just a small adjustment of the rules.
I suspect that won't happenLike
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RonnyLatYa says up
19 January 2021 at 01: 49
Indeed.
The solution is so obvious, but probably too simple and I think your guess is correct.Like
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puuchai korat says up
18 January 2021 at 12: 56
If someone has a Dutch (basic) insurance, I think that the relevant insurer should be so customer-friendly as to fill in a desired statement, if the requested amounts fall within the coverage. One could then add 'minimal'. And if not, as a customer I would consider choosing an insurer that is willing to comply. With such a refusal, I also think that the insurer raises the suspicion that it may not be able to meet this cover. A ridiculous assumption because in the Netherlands losses of a health insurer are 'equalized' annually by the other insurers. A refusal by an insurer to issue a statement is also not in accordance with the government's basic argument at the time for introducing basic insurance: market forces in healthcare. Well, you see, the market forces seem to have completely disappeared. Apparently, insurers are not at all afraid of losing customers. I have read several times in this blog that certain insurers have issued a statement. Read these articles again and take advantage of them. Dutch insurers are not allowed to refuse someone despite existing ailments.
I doubt whether the government can or will do anything about this. It's not their job either. They have provided an excellent framework. It is up to the insurers to implement this. And if they don't want to, they lose customers. Market forces, for what it's worth in healthcare.
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BramSiam says up
18 January 2021 at 14: 47
With all due respect to Ronnie as our visa specialist I have to say that this discussion is starting to take on absurd forms. The Thai government sets standards and everyone insured in the Netherlands meets those standards.
The current view seems to be that the amounts are exactly Baht. 40.000 resp. Baht 400.000 and USD 100.000. However, if you have an insurance policy that reimburses more on all fronts, such as all Dutch people who are compulsorily insured, then you no longer meet the requirements. Bad luck, you should not have been insured so well.
If you have an economy class ticket and the airline wants to upgrade you to business class, that is unacceptable. After all, you paid economy class. Very logical.
We have to adapt to all the absurd situations, but the Thai government still wants tourists, or so I thought. The concrete walls of a bunker are more flexible than the Thai government.
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Frank Teeuwen says up
18 January 2021 at 15: 49
I am insured with OOM and they were very helpful in providing me with a statement.
That was in September when it was only USD 100,000.
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Ger Korat says up
18 January 2021 at 23: 44
Dear Frank, it is still USD 100,000 for a Non Immigrant O visa unless you request retirement as a reason. For the other reasons (e.g. marriage or because of a family relationship) to apply for it, USD 100.000 cover and mentioning this on a policy is sufficient.
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ton says up
18 January 2021 at 16: 24
Dutch Government and insurance………………don't cut my mouth open.
As if it were yesterday, I remember the introduction of the Healthcare Act in the Netherlands by Mr. Hogevorst. All retired Dutch people who lived outside the Netherlands lost their Private Insurance immediately. When the law was drafted, that was simply………forgotten. The joint pensioners abroad filed many lawsuits. The arrogant Dutch government did not back down but deployed expensive lawyers to win the case and oblige pensioners abroad to comply with the health care law through a complicated treaty law obligation, with complicated country of residence factors to compensate for differences in health care quality between the countries. But that only applies to EU (and some) countries, but not outside, so not if you live in Thailand.
Don't think that a government that does this with health insurance customers will care one bit that Thailanders have to show insured amounts to Thai Immigration.
Freedom of movement is compromised. People who want to enjoy their pension (far) outside the Netherlands encounter major problems when taking out new health insurance policies at an advanced age.
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jo says up
18 January 2021 at 17: 47
I think a while ago there was a member of parliament from the D'66 who stood up for Dutch people abroad. His name has escaped me. This gentleman will also almost appear on the net again in the run-up to the elections
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Philippe says up
18 January 2021 at 20: 59
… and then you can … you can even … without 14 or 10 days of quarantine = wow !!! .. and then ? where are you going then?
The beaches and palm trees are still there but otherwise ?
Have seen recent images of Phuket (only been there once), Pattaya (never been) and Koh Samui (been many times when it was still Thai, but that's a long time ago) all, grim images everywhere = ghost towns !
You will almost be obliged to stay in your (top) hotel if you wish to consume / eat something …. other possibilities are or will be hard to find…
It will therefore be quarantine anyway, although with the freedom to view the desolate streets / places ...
I've been a fan of Koh Chang for years but it's no different there = dead as a door, sad... it hurts me.
Have friends living there and all say the same thing, the little ones are out / are gone … some large resorts have or will survive … and that's what really doesn't interest me, give me the small Thai bar, restaurant, beach hut … from the local Thai who, when you get there, put you back with both feet on the ground in terms of friendliness, respect, good food ... you name it.
If I can't find that anymore, what is the difference with a terrible all-in resort in the Dominican or in Gran Canaria.
We all hope for the green light, myself included, but I fear many will be disappointed not to find “those certain charms” of Thailand anymore, at least for the time being… I hope I am very much mistaken… I really hope so… and hopefully in September 2021 I will really know how it is... (I was forced to delete March) and hopefully I will see many of those lovely Thai people (young and old) again that I carry in my heart.
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If someone else's negligence injures you, you can try to recover damages. The first step usually involves filing a claim with the at-fault party's insurance company. Once you file a claim, the insurance adjuster starts an investigation.
What is insurance redlining? ›Homeowners insurance “redlining” is a form of discrimination in which an insurance company or agent treats homeowners differently because of the race or national origin of residents in the neighborhood where their home is located.
What are examples of red flag symptoms? ›- Severe chest pain – heart attack, clot in lungs, collapsed lung.
- Severe headache – bleed in brain, meningitis (a brain infection)
- Shortness of breath – heart failure or COPD (a group of lung diseases that cause breathing difficulties), asthma.
The auto insurance company with the most complaints is United Automobile Insurance, which receives roughly 40 times more complaints than the average insurer its size, according to the latest NAIC complaint index.
What is the biggest insurance claim? ›The Tohoku Earthquake & Tsunami of 2011
While the damages, for the earthquake alone, were estimated over $210B, only $35B was insured and ultimately paid out. The total combined payouts could be much higher.
“Ping An is the world's most valuable insurance brand for the seventh consecutive year, with a brand value of $32.2 billion,” noted Brand Finance. “The Chinese brand retains this title, despite a 25% year-on-year brand value reduction. Ping An's brand is now worth half of its value prior to the pandemic.”
How do you write a strong appeal? ›
- Opening Statement. The first sentence or two should state the purpose of the letter clearly. ...
- Be Factual. Include factual detail but avoid dramatizing the situation. ...
- Be Specific. ...
- Documentation. ...
- Stick to the Point. ...
- Do Not Try to Manipulate the Reader. ...
- How to Talk About Feelings. ...
- Be Brief.
- Your professional contact information.
- A summary of the situation you're appealing.
- An explanation of why you feel the decision was incorrect.
- A request for the preferred solution you'd like to see enacted.
- Gratitude for considering your appeal.
- Supporting documents attached, if relevant.
When you write an appeal letter, include facts and documentation that help support your case. Your letter should be clear about what you want to have happen and what outcome you are seeking. If you don't get a response right away, follow up with a second message or a phone call to check on the status of your appeal.
Can an insurance company decline a claim? ›Unfortunately, insurance companies can — and do — deny policyholders' claims on occasion. Some of the most common reasons for claim denials are exceeding the policy limit, lacking the needed coverage and breaking the law. Additionally, sometimes claims are incorrectly denied.
What are the disadvantages of canceling insurance? ›It could affect your premiums in the future
If you cancel your policies frequently, you may end up falling into a higher risk category. This could result in higher premiums, and it may even cause some insurance companies to refuse your applications in the future.
What is a CLUE report? A CLUE report shows the claims filed for any house or car for the past seven years. It lists claims on your home or vehicle, even if you weren't the owner at the time.
Should I answer insurance questions? ›Anything you say to the other driver's car insurance company can serve as a basis for refusing to pay you anything, or reducing the value of your claim. Only answer the question asked. Do not volunteer additional information or agree to have your statement recorded, whether it's over the phone or in writing.
Do I have to answer insurance questions? ›Keep reading to learn how to answer insurance questions after an accident. If you receive a call from the other driver's insurance company, you are not legally required to talk to them. If you do not want to speak to them, you can put them in touch with your lawyer.
How do you argue insurance? ›- Contact your agent again. Contact your agent again.
- Consider an independent appraisal. Consider an independent appraisal.
- File a complaint. File a complaint.
The difference between rejected and denied claims is that rejected claims occur before being received and processed by insurance companies. Denied claims have been received and processed by insurance companies. In most cases, rejected and denied claims can be corrected and resubmitted.
Can a claim denial be corrected and resubmitted? ›
If you've received a denial, you have the option to submit it again. Depending on the denial reason, you may only need to resubmit the claim with any corrected fields.
What steps would you need to take if a claim is rejected or denied by the insurance company? ›- Rectify and Reapply. Once you know the exact reason why the insurance company has rejected your claim application, do the necessary changes, and file the claim again. ...
- Approach an Ombudsman. ...
- Write an appeal letter to the insurance company.
- #1. Missing Information.
- #2. Service Not Covered By Payer.
- #3. Duplicate Claim or Service.
- #4. Service Already Adjudicated.
- #5. Limit For Filing Has Expired.
A claim with services "not medically necessary" would most likely be rejected.
What are the possible solutions to a denied claim? ›If your health insurer refuses to pay a claim or ends your coverage, you have the right to appeal the decision and have it reviewed by a third party. You can ask that your insurance company reconsider its decision. Insurers have to tell you why they've denied your claim or ended your coverage.
How likely are cases to be won on appeal? ›The chances of winning a criminal appeal in California are low (about 20 percent of appeals are successful). But the odds of success are greater if there were errors of law and procedure at trial significant enough to have affected the outcome of the case.
How do I dispute a rejected insurance claim? ›- Broker advocacy. If your claim is rejected, your broker can be your advocate. ...
- Internal dispute resolution. If your broker can't get the insurer to overturn the decision, the next step is requesting your insurer launch a formal internal dispute resolution process. ...
- External dispute resolution. ...
- Court proceedings.
How many home insurance claims are too many? If you've filed more than three claims in the last year, you'll likely face higher premiums, and it may become more difficult to get insurance coverage at all (via Money Crashers).
Can my insurance company drop me for too many claims? ›Insurers can cancel policies or choose not to renew at the end of a policy term. Non-renewal can occur after multiple accidents or filing too many claims. At the same time, more immediate cancellations can result from serious issues like loss of driving privileges or insurance fraud.
Why does my insurance keep denying my claim? ›Insurance claims are often denied if there is a dispute as to fault or liability. Companies will only agree to pay you if there's clear evidence to show that their policyholder is to blame for your injuries. If there is any indication that their policyholder isn't responsible the insurer will deny your claim.
What is a denial in insurance? ›
A denial is when your insurance company refuses to pay or denies responsibility to pay for medical services or treatment that has been provided to you or a family member.
What is denial in insurance? ›Denial of claim is the refusal of an insurance company or carrier to honor a request by an individual (or his or her provider) to pay for health care services obtained from a health care professional.
Can insurance be declined? ›The insurer can reject your claim if they have reason to believe you didn't take reasonable care to answer all the questions on the application truthfully and accurately. A common example is failure to disclose a pre-existing medical condition.
What type of loss is uninsurable? ›An uninsurable risk could include a situation in which insurance is against the law, such as coverage for criminal penalties. An uninsurable risk can be an event that's too likely to occur, such as a hurricane or flood, in an area where those disasters are frequent.
What are the most common reasons for a denial? ›- Claims are not filed on time.
- Inaccurate insurance ID number on the claim.
- Non-covered services.
- Services are reported separately.
- Improper modifier use.
- Inconsistent data.
Simple denial occurs when someone denies that something unpleasant is happening. For example, a person with terminal cancer might deny that he/she is going to die. 2. Minimization occurs when a person admits an unpleasant fact while denying its seriousness.
How do I avoid insurance denial? ›- Verify insurance and eligibility. ...
- Collect accurate and complete patient information. ...
- Verify referrals, authorizations, and medical necessity determinations. ...
- Ensure accurate coding.
A recent study by the Kaiser Family Foundation (KFF) of plans on the Affordable Care Act marketplace found that even when patients received care from in-network physicians — doctors and hospitals approved by these same insurers — the companies in 2021 nonetheless denied, on average, 17 percent of claims.
What is it called when an insurance company refuses to pay a claim? ›Bad faith insurance refers to an insurer's attempt to renege on its obligations to its clients, either through refusal to pay a policyholder's legitimate claim or investigate and process a policyholder's claim within a reasonable period.
What are 3 risks that are uninsurable? ›An uninsurable risk is a risk that insurance companies cannot insure (or are reluctant to insure) no matter how much you pay. Common uninsurable risks include: reputational risk, regulatory risk, trade secret risk, political risk, and pandemic risk.
What are 5 risks that are uninsurable? ›
There are five things that insurance companies consider almost completely uninsurable: reputational risk, regulatory risk, trade secret risk, political risk, and pandemic risk.
What are 2 examples of uninsurable risks? ›A risk that an insurer will not take on. For example, this may be where an event is inevitable (such as a terminally-ill person's death), gradual (such as rust or corrosion) or against the law.