Universal Provident, has published a breakdown of declined private medical insurance (PMI) claims for the second year running.
The major reason for declined claims during 2012 was failure to complete or return a claim form, which happened in just under two-fifths (38.1%) of all declinatures.
This was most common in cases where the policyholder had gone for treatment without authorisation.
This was followed by out-patient claims being submitted on an inpatient only policy (7.9%), GP services (7.9%), psychiatric conditions where the module had not been selected (6.3%) and conditions falling within the moratorium (6.3%).
Other reasons for declinature included chronic conditions, dentistry, routine monitoring, cosmetic treatment, hazardous pursuits, infertility treatment and the treatment cost being less than the policy excess.
In addition, two thirds of claims paid/declined in part were attributed to chronic conditions. Other causes included palliative treatment, rehabilitation, out-patient treatment on an in-patient only policy and dentistry.
Dale Tranter, assistant group underwriting manager said: "This latest release demonstrates our on-going commitment to a culture of openness with our broker partners."
Universal Provident has said to date, they are the only PMI provider to release such statistics.
