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A Non-Believer? Here's a Successful Critical Illness Claim Story

Updated: Sep 5, 2023

When my client informed that they might need to file a claim soon, a nightmare faced by financial advisors like me has started. When claims are requested, it can only mean two things, an untimely death or an unexpected illness. Both I hope I will not have to face early in my careeer. Am I ready for the challenge? Not really. I think no one will ever be. But what I'm prepared to do is be the lifetime partner to my client and help them in every step of this claims journey.

...may diagnosis na....Chronic Myelogenous Leukemia. Paano kaya magiging process natin?

In about four months after my client successfully applied for a critical illness plan, aptly called Sun Fit and Well Advantage, she was diagnosed with an uncommon form of Cancer. It was unexpected for I personally met and conducted her medical background check. Her application was approved meaning she successfully passed all the review and assessment procedures for insurability. They also just came back from a happy vacation trip abroad.

Just a few days after this memorable family-bonding, she felt unexplained exhaustion leading to the need to seek hospitalization. After a series of tests by her team of doctors, the result came out conclusive. Chronic Myelogenous Leukemia.

As with people that we know, illnesses are like thieves in the night. They can happen without prior warning. They can happen to the most health conscious individuals. How many family, friends, acquaintances do we know who are fit one day and suddenly fell ill? Shocking, right? As much as we want to avoid getting critically sick, there is no quarantee that we can. All we can do as responsible adults is to plan ahead and prepare for what may happen.

Mommy, focus on getting better. Dito lang ako ...

So our claims journey began. Medical records were requested and submitted. The Sun Life claims team reviewed the medical history of my client meticulously. Was it a disheartening process? Yes.

The first two years of an insurance plan is called the contestable period. This means an insurance company, Sun Life and the rest of the insurers in the Philippines, have the right to conduct their investigation prior to approving a claim. If misrepresentation of information was made in bad faith, then, claims may be disapproved.

Since my client's insurance plan is still within the contestable period, it was expected that Sun Life will conduct an investigation.

The considerably long process lead to feelings of frustration both on my client's and myself. I was anxious about how the claims will turn out. After all, it is my name and reputation at stake, being the financial advisor whom my client trusted.

Despite these negative emotions, one fact was clear to me. Sun Life will not remain number 1 in the insurance industry for many years if it cannot fulfil its fundamental commitment. To be a lifetime partner to Filipino Families.

Finally, our critical illness claims was approved! How much did my client receive ?

Insurance Claim

Amount in Pesos

Major Critical Illness Benefit

Php 1,000,000

Hospital Income Benefits

Php 22,750

Truly, hope is here. Armed with the cash benefits from our critical illness insurance plan, my client has more arsenal in their family's fight against her condition.

Being an expert in the Sun Life healthcare plans, I know that the amount officially released to us lacks a few more benefits. Sun Fit and Well Advantage is my personal plan. My family is protected by the same plan. Majority of my clients tursted the same plan for their healthcare. The dilemna, hence, was do I chase for the lacking benefits? After all, we have received a substantial amount. Doing so may re-open the assessment and who knows what the new decision will be. Nevertheless, I have full trust in Sun Life.

After challenging the total benefits released, Sun Life without further questions honored the rest of their commitment:

Subsequent Insurance Claim

Amount in Pesos

Post Hospitalization Benefit

Php 5,000

Home Recovery Benefits

Php 4,375

At this point, my client paid a total of only 1 quarter-worth of insurance premiums. This was sufficient for Sun Life to guarantee its commitment.

Sun Life even returned excess premiums that my client has paid after their illness diagnosis. Ito ang alagang Sun Life.

This is the power of an insurance plan. This is the power of trust.

Finally, Sun Life has fulfilled its promise. I have fulfilled my promise.


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