olice have named two former executives of PT Asuransi Allianz Life Indonesia suspects for allegedly refusing to grant medical claims of two customers in the country’s first criminal case implicating an insurance company.
The company’s former president director, Joachim Wessling, and former claims manager, Yuliana Firmansyah, stand accused of violating Law No. 8/1999 on Consumer Protection for allegedly breaching contracts with two customers by refusing to reimburse them for their medical expenses and instead setting additional requirements for the two to comply with in order to receive payouts.
Disputes between private insurers and policy holders in the country have been mostly processed under civil law.
Ifranius Algadri, 23, a resident of Tangerang, Banten, reported the insurance company to police on April 3, after failing to be reimbursed for medical treatment at the Omni Hospital in South Tangerang and the Mayapada Hospital in Tangerang.
Ifranius, who suffered from diarrhea and typhus, spent Rp 16.5 million (US$1,221) for treatment at the two hospitals. He was not reimbursed, even though he reportedly submitted all documents required under the policy, including a summary of his medical record.
Alvin Lim, who represents Ifranius and another customer, Indah Goena Nanda, in the case, said the company had asked his client to submit a complete medical record legalized by the hospitals, even though that was not mentioned in the policy book.
The hospitals rejected Ifranius’ request by referring to Health Ministry Regulation No. 269/2008 on medical records, which stipulates that patients can only get summaries of medical records, prompting the insurance company to reject his claim.
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