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Ministry of Health to simplify claim process for CareShield Life after Ms Sylvia Lim raised case of former resident who was denied payout

Following investigations into the case of a severely disabled elderly man called Mr K that was raised by Workers' Party Member of Parliament Sylvia Lim in Parliament during a debate on CareShield Life in July, the Ministry of Health (MOH) has announced that family members and caregivers of severely disabled Singaporeans will go through a "simpler claims process which will be more convenient for policyholders."

CareShield Life is a mandatory insurance scheme run by the Government which covers severe disability in old age. The insurance scheme is scheduled to be implemented in two years' time from now as a replacement for ElderShield.

Mr K passed away "within a month" before having his ElderShield benefits restored

Ms Lim raised the question as to whether CareShield Life would be using the same criteria for eligibility as the ones used for ElderShield.

The case of Mr K, one of Ms Lim's former residents, who suffered from severe kidney failure and underwent amputation on one of his legs as a result of diabetes, was brought up by the MP during the Parliamentary debate.

Ms Lim made an appeal for a reassessment of Mr K's eligibility on his behalf. However, he was served another claim form to fill up, and was admitted to a hospice.

The MP recalled in Parliament: "When I saw him there, he (asked) me to write to the insurer to say that he would not be filling up the form as he was in the hospice.

Eventually, his daughter filled up the form, and I understand that the hospice doctors assisted to get his ElderShield benefits restored."

However, Mr K passed away "within a month," said Ms Lim.

Insurer asked to reassess disability status within two months

In a Facebook post on Thursday (1 Nov), the MOH also declared that "all ElderShield assessments and reviews are performed by assessors who are trained by the College of Family Physicians Singapore (CFPS) and recognised by MOH."

Elaborating on the details of Mr K's case, MOH noted that the elderly man was assessed under ElderShield's eligibility criteria, and was found to have met the scheme's criteria of severe disability. As a result, Mr K's insurer began "providing ElderShield payouts from then."

In Sep 2016, Mr K was scheduled to undergo "an ElderShield disability review assessment," which is "in line with the practice of periodic reviews to determine if payout recipients still meet the ElderShield claims criteria," MOH said.

A panel doctor on behalf of the insurance scheme, however, concluded that Mr K was able to perform all six Activities of Daily Living (ADLs) stipulated in the conditions of the scheme, noting that Mr K would be able to do so with some assistance.

As a result, Mr K’s insurer stopped his CareShield payouts two years ago in Oct.

However, following an appeal from Mr K’s family, the same doctor subsequently carried out a second assessment the following month and had again concluded that Mr K had met the eligibility criteria for severe disability under the ElderShield scheme "based on new information obtained from Mr K’s past records and further observation of Mr K’s condition in Nov 2016," according to the ministry.

Subsequently, Mr K began receiving ElderShield payouts as a result.

However, "given the change in assessment outcome within the short period of 2 months, the insurer asked Mr K to obtain a second opinion to confirm his disability status before resuming payouts," MOH revealed.

The ministry also added that Mr K's insurer only "resumed the ElderShield payouts in Apr" the following year "after Mr K’s hospice submitted an assessment that showed that he was severely disabled then," and that "it will back-pay Mr K’s ElderShield benefits from Oct 2016 to Mar 2017."

Not an isolated case

Prior to Ms Lim's case, Mr Jose Raymond from the Singapore People's Party, shared another case where a senior who was denied his payout by NTUC income despite being certified as being blind. The insurer had written to the blind senior, stating that he did not qualify for the benefits as he is still able to perform more than three ADLs.

Many netizens have commented that if not for Ms Lim raising the matter in Parliament, MOH would have allowed the issue to continue, where insurers could deny payouts even when the beneficiaries clearly meet the conditions.