Ardhi, Muhammad Maulana (2024) Perlindungan Hukum Terhadap Nasabah Yang Mendapatkan Penolakan Klaim Asuransi Kesehatan di Indonesia. (Legal Protection for Customers Who Get Rejected Health Insurance Claims in Indonesia). Undergraduate thesis, Universitas17 Agustus 1945 Surabaya.
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Abstract
This research aims to find out and understand customer obligations so that claims can be accepted and claims are not rejected by health insurance companies in Indonesia and related to legal protection against claim rejection for health insurance customers. The type of research used is normative research using the Legislative Regulations approach; conceptual approach; and the case approach in Decision no. 155/Pdt.G/2012/PN.Jkt.Ut and Decision no. 620/Pdt.G/2014 PN.Jkt. Sel. So it is found that in order to avoid claim rejection, the customer as the insured must first understand his obligations in accordance with the policy, namely, first, the customer pays the premium according to what is calculated; Second, customers have the right to provide true information; Third, customers are obliged to provide evidence, namely by completing the documents required for submitting a claim no later than 30 days after the end of health care. Furthermore, in the case of submitting a claim, the insurance company is obliged to carry out an investigation of the files, where if the submission does not comply with the provisions of the insurance policy, the claim submitted will be rejected. Regarding the legal protection of customers as insured, there are two legal protections, namely first, internal legal protection created by the insurance company for the benefit of the insurer and the insured by forming an insurance policy. Second, external legal protection created by the authorities through the formation of regulations aimed at the interests of weak parties without favoring certain parties as in the 1945 Constitution of the Republic of Indonesia; Law Number 8 of 1999 concerning Consumer Protection; Financial Services Authority Regulation Number 38/POJK.05/2020 concerning Amendments to Financial Services Authority Regulation Number 69/POJK. 05/2016 concerning the Implementation of Insurance, Sharia Insurance Companies, Reinsurance Companies and Sharia Reinsurance Companies; OJK Regulation no. 6/POJK.07/2022 concerning Consumer and Public Protection in the Financial Services Sector; Civil Code; Commercial Code. Meanwhile, efforts to protect claims rejection disputes can be resolved non-litigation as per OJK Regulation No. 61/POJK.07/2020 concerning Alternative Institutions for Dispute Resolution in the Financial Services Sector and litigation through the courts.
| Item Type: | Thesis (Undergraduate) |
|---|---|
| Uncontrolled Keywords: | egal Protection, Insurance Policy, Claim |
| Subjects: | K Law > K Law (General) |
| Divisions: | Fakultas Hukum > Program Studi Ilmu Hukum |
| Depositing User: | 1311900338 Muhammad Maulana Ardhi |
| Date Deposited: | 23 Feb 2001 20:02 |
| Last Modified: | 23 Feb 2001 20:02 |
| URI: | http://repository.untag-sby.ac.id/id/eprint/31624 |
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