Updated: Nov 30, 2021
I believe many of you out there had read the news regarding an insurance company getting sued by a client regarding a critical Illness claim which is been rejected. Claim rejected…. After paying for more than 2 years?? How can this happen?? And we can see a lot of comments on social media where netizens voice up their opinions. Some say is correct for the insurance company to act according to the law, some say is not. Let me share with you my opinion.
Ok. Let us take a look at the case. According to the report, the client had her claim filed on Aug 12, last year, as mentioned by the client she bought the first policy in 2015 with a half a million basic sum assured and a monthly premium of RM600 payable for 20 years. In 2018, she signed up for a second policy with a RM2mil basic sum assured and a monthly premium of RM1,666.70 payable for 61 years. According to the client, she had truthfully filled in her information in the forms and made full disclosures in line with the Financial Services Act on her health. In 2018, the client was diagnosed with cancer and she started to filed claims. All of the claimed approval except for one company.
The reason the insurance company had rejected her claim is due to her medical history which the client had consulted a doctor and took prescriptions on anxiety and some sort of infection in 2014 and 2017.
Ok…. from my opinion. My opinions ar… there might be a misunderstanding between both parties. Especially during the applications and health declarations process. From the client point of view, maybe she thought that she had fully recovered from the illness and there is no need to declare it. But, during the claims insurance company will follow according to the Financial Services Act 2013 to investigate and approve the claim.
I believe we hear this a lot “After 2 years, the policy is in force, usually claimed will be approved and no problem. Pass the contestable period already ma…”
But actually, even after 2 years, if the insurance company had found out any non-disclosure of illness or disability, the company had the right to actually void the policy, rejected the claim and refund all the premium paid to the client.
So, my advice is, must declare. Even you got asthma which already recovers, gastric problem or any surgery before must declare during the applications and submitted with a medical report to the company. That is the safest option.
Lastly, Insurance and Takaful companies were regulated by Bank Negara and they cannot simply decline a claim without solid proof. And as a client it is very important for us to have more understandings of insurance knowledge on claims, waiting period and the rules and regulations of the contract before and after we purchase the policies.
That’s all from me. Thanks and have a nice day.