In short
If the physician's insurer refuses the loss, what is read is the reason the refusal writing called outside cover; the writing is not a finding of fault. If the writing says which situation it left outside, that sentence governs. What the policy is, is not on this page. A payment amount is not promised.
The reason paragraph of the refusal writing
The patient looks at which paragraph the reason stands in, in the writing the insurer sent. If the paragraph says outside cover, it should name which situation it left outside. If there is no naming, the absence is not closed. If the writing refers to a policy article or to a clause of the general conditions, the reference is read. The reference does not stand in for the writing's own sentence. If the sentence and the reference conflict, the two stand side by side. The conflict is not reduced to a single reason.
If there is an amount in the writing, the amount is read from the writing. If it does not stand, it is not completed. A partial refusal and a full refusal are not the same sentence. If the writing leaves one item outside and another item inside, the separation is on the writing's own line. While there is no separation, the whole request is not treated as refused. If the name of the refused item is not in the writing, the name is not carried from another file. Whether the writing was sent to the patient or to the physician is read from its addressee. If the patient sees in his hand a copy written to the physician, the copy is not treated as served on him. Service is in the envelope or in the transmission record. If there is no record, a date of seeing is not assumed. If more than one policy is mentioned, each policy is read with its own reason for refusal. If one was refused and there is no writing about the other, the absence stands separately. The absence is not a refusal of the second policy either. If the policy period stands in the writing as one year, that year is read. If it does not, the period is not pasted onto this event from a retrospective sentence in the general conditions.
Situations that remain outside cover
The general conditions count, under their own heading, the situations that remain outside cover. Claims arising from activity outside the field whose limits are drawn by legal rules or by ethical rules, outside the professional activity within the policy, are outside. Except the performance of a humanitarian duty, activities outside the area of responsibility of the institutions within the policy are outside as well. Every kind of penalty and penal clause, including administrative and judicial fines, is outside. Except what is done as required by medical professional activity within the frame set by the relevant legislation, claims arising from an experiment are outside.
This list is not put in the place of the refusal writing. If the writing built another sentence, that sentence is read. The list does not write the amount to be paid either. The limit is in the policy. This page does not put a limit figure. If the writing does not use the experiment clause, the patient does not have to name the event an experiment. If the writing says outside the professional activity, it should say which act it left outside. If the act is not in the writing, the act is not completed.
The deductible, notification, and the period
A deductible, notification, or the policy period may be other lines of the writing. They are not a repetition of the heading outside cover under another name. The patient takes the writing's own heading as the basis. The period and the limit are not memorised in this text. The notification burden in the general conditions is directed at the person who took out the insurance. That burden is not pasted in the place of the reason in the patient's refusal writing. If the writing says a delay in notification, it is read to which date it tied the delay. If there is no date, a delay is not assumed.
The definition of the policy, the premium, and the frame of the direct application are in the article compulsory insurance. This record does not rewrite that definition. If the policy number is in the refusal writing, the number is kept. The number does not of itself show the cover amount. If an additional schedule is mentioned in the writing, the schedule is looked for as an annex of the writing. If there is no schedule, a schedule is not treated as existing. The general conditions write that the risk will be treated as realised at the moment the insured learned of the compensation request, or the person who suffered harm applied directly to the insurer. This sentence does not change the reason of the refusal writing. The date of the application and the date of the refusal are put side by side. If one is absent, the other does not stand in for it. The patient keeps a copy of his own application petition. If there is no copy, the refusal writing does not of itself recount the content of the application. If the refusal writing uses a word such as intention, the word is in the writing's own paragraph. The word is not a court decision. This page does not build a list of intention. If the writing does not use this word, the patient does not name the event with that word.
The names of the items are in the article heads of compensation. The refusal does not bind, as a judgment, that those items exist or have ended. The general list of an application made to the hospital is in the article patient rights. The insurance refusal writing is not an item of that list. The definition of the consent form is in the article informed consent. The form is not put in the place of the reason for refusal.
The refusal is not a finding of fault
The insurer's refusal is not a decision that the physician was at fault, or was not. Article 1478 of the Turkish Commercial Code writes that the person who suffered harm may claim directly from the insurer the part of the harm up to the insured sum, on condition of remaining within the limitation period of the contract. The sum is read from the policy. This page does not write the sum. The direct application does not turn the refusal writing into a judgment of fault. If the writing says that the application cannot be made at all only in its own sentence, that sentence is read. If there is no sentence, the route of application is not treated as closed.
A court or administrative examination is not pasted in the place of the writing. The writing does not announce the amount to be paid. If the insurer has an inquiry note, the note is not a decision. If the note and the refusal writing conflict, the conflict is not closed. The patient separates, from the envelope or the email record, which writing was served on him. If there is no service, the writing is not treated as seen.
A refusal without a reason
If the writing only says it was refused, it is left as there being no reason. The absence is not filled by choosing a situation outside cover. The patient keeps the date of the writing and which application it answered. If the date of the application is not in the writing, the absence is marked separately. A second writing that comes from the same insurer changes the first only if it says so. If it does not, the two writings stand side by side. If the first is without a reason and the second has a reason, the reason is in the paragraph of the second. If the second writing does not carry a reason either, it is still not completed.
If the refusal writing is in your hand, the reason may be read separately through contact. The reading is not a promise of payment. A reading that is not a promise does not build a finding of fault either. If the route of insurance arbitration or of court stands as a sentence under the refusal writing, that sentence is read. If there is no sentence, the route is not treated as closed, or as opened, of itself. The period is not written in this text as a number of days. If the day is in the writing's own text, it is read from there. If it is not, a memorised period is not added. If the writing says the physician's professional activity remained outside the branch written in the policy, the name of the branch is read from the writing. If there is no name, the branch is not completed. The humanitarian-duty exception is not assumed if the writing does not discuss this exception. The exception is not added to every refusal writing under the short name of the sentence in the general conditions.
The definition of the policy is not on this page
This record does not recount again who the policy covers and with whom the premium stayed. The patient does not put the refusal writing in his hand in the place of the definition of the policy. If there is a copy of the policy, the copy stands beside the reason for refusal. If there is no copy, the cover is not invented from the refusal writing. If the insured's name appears in the writing, the name is read. If there is no name, the physician is not guessed from the title in the writing. The guess does not change the reason sentence. If the insurer's headed paper and an attached account statement are on separate pages, the statement does not stand in for the reason for refusal. If there is a figure in the statement, the figure is read from that page. If there is no statement, the figure is not produced from the general conditions.
A geographical limit is a separate heading in the general conditions. If the refusal writing does not use this heading, the patient does not characterise the event as outside the limit. If the writing uses it, it says which place was left outside. If there is no place, the place is not completed. If there is no copy of the policy in the annex to the refusal writing, it is left as there being no annex. A limit is not drawn from the general conditions as if there were an annex. The patient keeps how many pages the writing is, and the order of the pages. A missing page is written as missing. A missing page is not turned into an assumption that the reason was completed.
Conclusion
If the physician's insurer refuses the loss, the patient reads the reason outside cover in the refusal writing. The situations left outside in the general conditions are not pasted in the place of the writing. The definition of the policy and the payment amount are not on this page. The refusal is not a finding of fault. The frame is on the health law page. The basis is the general conditions, together with article 1478 of the Turkish Commercial Code.