Sinambela, Mutiara (2023) Tinjauan Hukum Penolakan Klaim Asuransi Kesehatan Terhadap Masa Tunggu Di Pt. Prudential Pekanbaru. Other thesis, Universitas Islam Riau.

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Abstract

ABSTRACT Insurance is a human need, we know that insurance can provide protection for the transfer of risk suffered by every human being, namely the event that is uncertain when it oceurs, but the problem that often occurs is that the insured neglects his performance to pay premiums, some insured do not make premium payments and does not pay premiums on time, the result of late payment of premiums is that the insured's poliey will become inactive and will not be able to file claims. The main problem in this study is how the rejection process carried out by PT. Prudential when the insured's policy is in a waiting period and what are the legal consequences when a claim is rejected by the insurer on the grounds of lapse at PT. Prudential. The type of research used in this research is observational research bymeans of a survey, while its nature is descriptive, namely research that aims to provide a more precise and concrete picture. The results of this study indicate that the procedure for submitting and rejecting claims at PT. Prudential is relatively simple, but the process of rejecting claims at PT. Prudential cases are not uncommon, which are caused by various things, one of which is the result of the policy being in a waiting period. As for the legal consequences if a life insurance claim is rejected by reason of the waiting period it can cause losses to the community because they cannot exercise their rights besides that the legal consequence is also the loss of public trust in insurance institutions. Meanwhile, the process of settling premium arrears by the insured is nonlitigation, namely by way of deliberation and litigation. Litigation is a legal action carried out through court channels. And if the insured party has the desire toreactivate the policy, a maximum period of twenty-four months will be given starting from the unpaid premium period and will be due until the policy recovery date and fill out a form containing a health statement for poliey recovery.life insurance, lapse, insurer, insured.

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