Heart wrenching experience
DPC Yung Wai-kwong: "Always read the fine print"
IT was a long and winding road that finally led to the pay out of a claim by Detective Police Constable Yung Wai-kwong for a critical illness benefit.
His case reveals the importance for police officers to have an adequate understanding of their own insurance policies.
Fifty-two-year-old DPC Yung, from Wanchai District, received cardiac catheterisation (a form of invasive heart surgery) after he was diagnosed with heart problems last July.
As a holder of a Basic Plan and Critical Illness insurance policy since 1993, he made a claim to his insurance company but was shocked to find that he had been denied compensation because he had not undergone three of the diagnostic criteria which the insurance company said were necessary for remuneration following a first heart attack.
"My illness met the policy's criteria of 'new electocardiographic changes' and 'a current history of typical chest pain'. However, my doctor had not conducted a cardiac enzyme test and therefore I did not meet the last criteria of 'current elevation of cardiac enzymes'," explained DPC Yung.
"The Chinese version of the insurance policy led me to believe that if I ever suffered a heart attack I would be covered. However, when I signed the policy document, which is in English, the insurance salesperson had not explained the three criteria to me."
After his claim was rejected by the insurance company following several attempts to resolve the matter, DPC Yung sought assistance from the Hong Kong Island Regional Welfare Office. There, Assistant Police Welfare Officer Vincent Tsui Fee-hung took up the challenge and wrote to the insurance company, expressing his concern.
Basically he argued that Mr Yung's heart specialist, after careful observation and treatment of his patient, made a professional judgement and did not deem it necessary to conduct a cardiac enzyme test. If the insurance company continued to insist the enzyme test was necessary -Ü or the only course of diagnosis -Ü then the company should produce strong medical evidence to support their criteria. They did not.
After several months of deliberation, the insurance company agreed to honour Mr Yung's claim "on an exceptional basis" by paying him US$20,604 in April.
Says Mr Tsui: "DPC Yung's case demonstrates that our police officers must clearly understand the definitions of coverage of insurance policies that they intend to buy. It is advisable to read the terms and conditions carefully before signing any document -Ü and to ask for more information if you have any questions."
"Meanwhile," he added, "always remember that the simpler the terms the better."
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