Frequently Asked Questions

General

What is CCRP?

The Clinical Claims Resolution Process (CCRP) is a voluntary claims resolution process that provides insurers, doctors, medical institutions and policyholders an avenue for recourse, in clinical matters pertaining to Integrated Shield Plan (IP) claims.

Parties should attempt to resolve the disputes amongst themselves at first instance. For example, policyholder with clinical-related issues against the IP insurers’ decision to turn down their claim, should show that they have not been able to resolve the dispute with the IP insurer before filing an application request with the CCRP. This is because all IP insurers have claims and complaints management capability that can deal with specific issues from an individual’s purchased IP Plan.

What type of disputes will not be considered by the CCRP?

Disputes relating to non-IP claims will not be considered by the CCRP. These would include disputes relating to life insurance or accident policies.

The CCRP is a platform for IP disputes of a clinical nature. For example, this would include why the claim for a particular procedure was rejected, even when the doctor said it was medically necessary.

For contractual disputes (e.g., whether the insurer has the right to terminate a policy after a claim is made), policyholders should resolve directly with their IP insurers in the first instance. Policyholders may also refer to the Financial Industry Disputes Resolution Centre (FIDReC)’s website at www.fidrec.com.sg for further information.

Patient-policyholder, doctor or IP Insurer can refer the case to regulators at any time.

Can restructured hospitals also use the CCRP?

Yes, both restructured and private hospitals may use the CCRP.

How can I convey my feedback or suggestions to CCRP?

You may email your feedback or share your experience with the CCRP Secretariat by clicking here.

Payment

When do I need to make payment?

You will be notified to make payment once CCRP Secretariat receives agreement from the Respondent to proceed with the resolution process.

How much do I have to pay for the Application Fee?

You may refer to the Table of Fees under Step 4 for the category that you belong to.

Application

Is my case eligible for CCRP?

The case that you are requesting for CCRP determination cannot be more than six months after the IP insurer’s final reply.

I wish to raise an application request against a certain party. Will they be notified of my application against them?

As the CCRP is a voluntary process, CCRP will contact the Respondent to obtain their agreement for the dispute once CCRP receives the Applicant’s signed Request for Determination (RFD) form. Hence, both the Applicant and Respondent will be aware of each other and of the request that is made.

This agreement is a contract that stipulates parties agree to abide by the decision of the CCRP panel and this may include payment of the whole IP claim or refund of any excess charges.

It is important to note that the case materials (e.g., both parties’ identities, medical records etc.) would be de-identified (with details anonymised) when submitted to the CCRP panel members for their review.

I wish to submit an application via the CCRP. Will the CCRP involve hearings?

The CCRP panel’s deliberation process would be conducted via a document-based review. There will be no need for parties involved to appear before a hearing. However, the CCRP Secretariat may request for further evidence to be submitted during the deliberations. Should this be needed, the CCRP Secretariat will notify the parties concerned as appropriate.

How is the CCRP evaluation conducted?

The evaluation by the CCRP panel will be conducted via an anonymous document-based review of statements and case materials submitted by the parties involved. Case materials will be de-identified before being reviewed by the CCRP Panel members, which will comprise 3 medical specialists from the Academy of Medicine, Singapore (AMS) and 2 medical directors from select IP insurers recommended by Life Insurance Association (LIA). A representative from the Consumers Association of Singapore (CASE) will also sit on the panel as a non-voting member to provide a layperson’s view to ensure the policyholder’s interests are considered by the Panel.

The determination by the CCRP Panel will be made by a simple majority of votes.

How long will it take for CCRP to resolve my dispute?

The CCRP will aim for an average turnaround time of 12 weeks for all cases upon receipt of all the relevant documents and statements from both parties. The turnaround time may vary or be revised depending on the caseload and complexity of each case.