As soon as an accident or illness strikes, if the agent and AIA Insurance Company provide timely and adequate support, the customer will be well protected. However, the customer has spent nearly 9 years languishing in pain and illness, gradually losing faith in insurance.
Insurance helps many people reduce the burden when facing risks, but there are still many people who are tired of the long process of claiming compensation.
Legitimate rights are affected, the insured - the patient is not only deprived of the opportunity to have a large amount of money to promptly access good treatment methods in the "golden period", but their relatives also have to bear the financial burden and mental fatigue.
From the pride of the family, suddenly suffered a traumatic brain injury
Early afternoon on a day at the end of 2024, Ms. Nguyen Thi Them was taken by her sister to the Ho Chi Minh City Medical Assessment Center to register for procedures, from there to hospitals to assess the disability rate, to have a basis to submit to the life insurance company.
“Where is this? I’m so hungry. I don’t know the way home. I’ve forgotten everything,” she said, her mouth twisted to one side.
Then she held the reporter's hand and placed it on the left side of her forehead to feel the deep hollow, a part of her brain was crushed and had to be permanently removed after a traffic accident nearly 9 years ago (May 2016).
According to the surgical report provided by Military Hospital 175 , at the time of the accident, Ms. Them was diagnosed with severe traumatic brain injury - subdural hematoma, cerebral contusion, left hemisphere hemorrhage, and right temporal subdural hematoma.
After receiving a referral from the medical examination center, we quickly went to Nguyen Trai Hospital (District 5) to examine Ms. Them's head.
This work should have been done nearly 9 years ago, right after the accident happened, everything was still new, but according to the family, because they were not guided by the insurance agent, it was not until the end of 2024 that the family met a competent person and guided them to carry out the procedure.
Sitting against the hospital wall, looking at her sister in a daze, Ms. Nguyen Thi Thu (biological sister, a tech-based driver) shed tears: “Our family only has one child, Them, who is in college. Before the accident, she was very good, working as a chief accountant, then working part-time for many other companies. She was doing well. Who would have thought that she would have had an accident not long after giving birth.
After the surgery, when I woke up, I could not remember anything. I did not know the names of the spinach, the chicken, the frog… I did not know who my parents, husband, children, or sisters were. I had to be taught from the beginning, little by little, like a baby.
Unable to work, still have to pay insurance premiums
For nearly 9 years, the whole family has had to work hard to help Ms. Them with her treatment. Although she has life insurance, it seems to only bring more resentment.
“My brother lost his memory and was unable to work. His condition was so severe that the insurance only paid out a few tens of millions of dong. Every year, the family had to pay life insurance premiums for him so that the contract would not lapse... It was so strange. I lost faith and sometimes I just wanted to quit,” Ms. Thu shared.
Immediately after Tuoi Tre newspaper reported the incident, AIA Insurance immediately intervened, issuing a referral letter for the customer to undergo a health assessment. By the end of November 2024, the City Medical Assessment Council (Ho Chi Minh City Department of Health ) had issued an official report, determining that Ms. Them's body injury rate was 82%.
With the above results, the customer quickly sent a request to the insurance company to pay benefits for: permanent total disability, critical illness, and payment of all interest due to late payment of the above two items. At the same time, it was requested to refund all premiums paid after the brain injury. The total estimated amount is over 1 billion VND.
After receiving the medical examination results, on December 12, the insurance company agreed to pay insurance benefits including: permanent total disability (450 million VND, divided into 10 payment installments), critical illness (200 million VND) and refund of insurance premium (153,000 VND, calculated from the examination results near the end of last month).
Although happy to be compensated, the customer's family continued to complain because they did not fully agree. Because the date of the insurance event that caused Ms. Them to suffer total and permanent disability and critical illness was 2016, not since the assessment results (November 2024).
Therefore, for the insurance premiums paid, the company is requested to return nearly 72 million (not 153,000 VND as above) since the accident occurred and with interest, as well as pay interest on late payments for critical illness and permanent total disability benefits.
Want to be resolved reasonably, fairly, and in compliance with the law
In mid-December 2024, the insurance company sent a reply letter to Tuoi Tre newspaper about the whole incident, along with the latest payment decision.
Accordingly, AIA said it paid a total of VND40.4 million to additional customers between August 2016 and February 2021, related to hospitalization/surgery benefits.
Specifically, the first treatment was for "Traumatic brain injury, right temporal bone fracture, small amount of right temporal epidural hematoma, left temporal epidural hematoma, scattered subarachnoid hemorrhage, diffuse cerebral edema in both hemispheres".
The next time, the diagnosis was “Left hemisphere skull fragment resorption surgery with titanium”. Since then, the company has not seen any further requests from customers regarding insurance claims settlement.
It was not until the end of October 2024 that the customer requested the company to settle the insurance benefit of “Total and Permanent Disability”. Therefore, the company issued a letter of introduction to the Ho Chi Minh City Medical Assessment Council to assess the disability rate.
Based on the appraisal conclusion, in mid-December 2024, the company agreed to pay "Total and Permanent Disability" benefits to Ms. Them (total amount of 450 million VND, divided into 10 installments), and critical illness insurance benefits (200 million VND).
AIA shares in the spirit of supporting and accompanying customers to overcome difficulties. In addition to the insurance premiums mentioned above, the company has also listened, considered, and flexibly supported the refund of all fees paid by the customer at the time of the accident (May 2, 2016) with a total refund of nearly 72 million VND, "with the desire to help the customer's family cover part of the costs during this difficult period".
Thus, AIA Insurance has just officially decided to pay a total of nearly 722 million VND to customers.
As a result, the customer representative said that the insurance company had shown its responsibility, but had not yet thoroughly handled the situation to compensate for the damages.
According to the law, insurance agents are responsible for "arranging compensation and paying insurance money when an insurance event occurs". However, since the time Ms. Them's family submitted the application (in August 2016), the company's professional department and the contract service agent have not promptly supported the medical examination referral, so that the family can take Ms. Them to have her disability assessed.
The interests of customers have been severely affected over the years. Therefore, in addition to the obligation to compensate for insurance benefits, customers require the company to pay interest to compensate for the damage.
In a response to Tuoi Tre newspaper in mid-December 2024, AIA Vietnam affirmed: "We always strive to provide dedicated, transparent and flexible support to ensure that customers' interests are resolved in the best way."
On December 31, 2024, the insurance company's call center called the customer's representative to notify them of their agreement to pay the total permanent disability and critical illness insurance benefits from the time the event occurred, plus interest. These compensation payments will begin to be transferred to the customer at the beginning of the new year 2025.
Source: https://tuoitre.vn/chi-tiet-truong-hop-bi-chan-thuong-so-nao-vua-duoc-aia-boi-thuong-sau-9-nam-20250107171121313.htm
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