Defective claims

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  • #22664

    I have got myself confused again about when a claim can be defective, and would like to check other people’s points of view.

    old HBR 72(9) says: [quote:4924df0c42]A claim made on an approved form… is properly completed… if completed in accordance with the instructions on the form, including any instructions to provide information and evidence in connection with the claim.[/quote:4924df0c42]
    However, our claim form currently includes the following phrase (lifted directly from the HCTB1): [quote:4924df0c42]If you cannot send the proof we need at the moment, send the form back to us now and send the proof later. We can start to process your claim, but we will not be able to pay you any benefit until we have all the proof.[/quote:4924df0c42]
    As we are telling people that they don’t have to provide all the evidence with the form, does that mean that we can’t say these claims are defective if the evidence is not provided?

    Will this limit our defective claims only to those where questions on the form itself have not been completed?


    It would include the information to be effective. The instructions say to send the form in and the missing information later. To clarify we should go out once we have received the form asking for the information and giving the month time limit. The situation is then totally clear to the claimant and have up to 2 months from the intention to claim to be entitled from that date.

    Our only other option would be to remove the instruction to send the form in right away. That could impact on the date of claim if sent in late, loose the claimant entitlement and cause all types of problems and challenges, so for good cutomer service we should do it this way.

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