The main reason claims are denied is a simple failure to complete the paperwork, Universal Provident has said.
The insurer, has released a breakdown of declined claims for 2011 showing lack of form filling as the reason in 46% of all declinatures.
This was most commonly in cases where the policyholder had gone for treatment without authorisation.
This was followed by chronic conditions (8%), psychiatric conditions where that policy module had not been selected (6%) and the conditions falling within a moratorium (6%).
Other reasons for declining included dentistry, being an out-patent treatment in an inpatient only policy, cosmetic treatment, hazardous pursuits and infertility treatment.
All claims paid/declined in part were attributable to chronic conditions.
Dale Tranter Assistant Group Underwriting Manager, commented: "With Groupama's PMI book being taken over by Simplyhealth, we are now the only PMI provider to disclose claims statistics to brokers who request it on all our Group PMI policies.
"This latest release demonstrates our ongoing commitment to a culture of openness with our broker partners."
Reason %
Claim form not returned with charges invoiced 24
Claim form not returned, no charges invoiced 22
Chronic conditions (not acute flare-up thereof) 8
Psychiatric condition (relevant module not chosen) 6
pre-existing condition/within moratorium 6
Out-patient treatment on an I/P only policy 4
Routine monitoring 4
Hazardous pursuits 4
Pregnancy/childbirth 4
Dentistry 4
GP Services 4
Charges below excess 2
Surgical appliances 2
Cosmetic Treatment 2
Fertility/infertility treatment 2
Second Opinion 2
Universal Provident, which provides private medical insurance (PMI), income protection, MPPI, dental, travel and long term disability care insurance products, is part of Personal Group, a provider of employee benefits and financial services.
In total, the Group provides benefits for 1.2 million employees
