Have you tried making a complain to Bank Negara Malaysia?

Still pending for the results of appeal.
If decline again, will appeal to BNM.

I am very frustrated and angry with Great Eastern Insurance Company.     

A month ago, I brought my mother for treatment to Sime Darby Medical Center, as my mother was experiencing PR bleeding (bleeding when she goes to toilet) and stomach pain for 3 days continuously. The doctor has stated the illness as "Colitis", and has urged my mother to be admitted and undergo endoscope and other necessary treatments ASAP.

But, to my shock, Great Eastern has declined the admission Guarantee Letter (GL) . When I called their customer service asking for the reason, they were giving many reasons such as my mother is a new customer (11 months old), no sufficient information,  they suspect this might a pre-existing illness and many more. After numerous phone calls, I was still not able to understand on what basis or exclusion term they have declined the guarantee letter. They are just guessing that it could be this or that or this, and based on that, they are declining me my benefits. When I asked them to justify and validate their speculation, they said they will need to investigate and that will take approx 2 to 3 months. How could a patient wait for 3 months? Are they out of their mind?

The next day I brought my mother to Selayang Gvt Hopt for treatment.

Then, I have submitted an formal written complaint to the insurance company, and they responded, giving me the same biased reasons, which I am not willing to accept. I feel cheated by this company and I have lost my trust in this company. They are giving many invalid reasons to deny GL for a genuine case. I have asked to terminate my mother's policy, and full refund of the premiums that I paid, but they resisted on that.
I am thinking of taking legal action against this company, if its posibble. Hence, I would like to get advice if the case can be fought in court, and what are the chances of winning.

Please help. I feel that this company is cheating me.  Despite my mother being a medical insurance holder, I still had to bring her to government hosp where the waiting list for treatment is longer. They are taking my money, but not giving me what I deserve.They are not being fair. I want justice. Please advice.

Thank you.

i am not insurance agent. But i think your complaint and some of the replies are speechless.

the insurance company did not say do want to pay you. Just they asking u to pay first then claim back later if your case is genuine after investigation. So simple.

As a consumer or policy holder, i think the investigation is reasonable in this situation. Dont be afraid to pay first if your case is really genuine. You are afraid to pay first because you afraid that the insurance company may not pay you back later

Hi all you there, Just for your infomation only,  You need to be carefully especially MAAKL MUTUAL BERHAD. They (UTC) were allowed to practise switch between funds to collect the dividend. When dividend collected then switching to other fund to collect the dividend so the dividend payout of a fund will dilute the fund price (switching will cost the investors).

FIMM also said it is allowed as it will avoid the timing risk. I am really speechless and I think they have lacked at all.

They (UTC) also recommended anyone buying "unapproved product". You will be the next victim so.. FIMM, Securities commission and MAAKL MUTUAL BERHAD said not responsible at all. SO Carefully ya.. OK

I have made my complaint to FIMM but unfortunately they replied me that there no misconduct. It is because i have signed on the switch form.

MAAKL UTC asked me to sign my name in the form "faster" without asked me to read the "Rules, Regulations, Laws, Policies, and Guidelines" first.

SO how? Too bad.. Carefully! OK

FIMM still lacking....no safe...

In Malaysia, all insurance companies is like this, giving them money for them to enjoy is right, claiming from them are wrong.
So I never buy insurance anymore, as the policies are not protecting my interest.

what they mean by signing switch form?  

what they mean by signing switch form?  
not all insurer is like that la bro . . . just that you pick a bad apple, you forever dont eat apple meh
thrust me 8 years in this line, insurance still have the beauty of it if not miss selling / cheat cust & etc cases
due to nature of human

Hi all you there, Just for your infomation only,  You need to be carefully especially MAAKL MUTUAL BERHAD. They (UTC) were allowed to practise switch between funds to collect the dividend. When dividend collected then switching to other fund to collect the dividend so the dividend payout of a fund will dilute the fund price (switching will cost the investors).

FIMM also said it is allowed as it will avoid the timing risk. I am really speechless and I think they have lacked at all.

They (UTC) also recommended anyone buying "unapproved product". You will be the next victim so.. FIMM, Securities commission and MAAKL MUTUAL BERHAD said not responsible at all. SO Carefully ya.. OK

I am having similar situation recently. In the midst of appealing now.
GE declined my claim with reasons which is not acceptable.

In short:
--> the time they approach, anything CAN CAN CAN.
--> the time we need claim, they will decline with all kind of funny funny reasons to leceh us.

         

Mind letting us know the reason of declination?

As a ex-GE staff, in order to decline a claim, we have to open a physical file and write down our justification and proof. Usually the whole file consist of 10+ pages for a single case and it's not an easy process to decline a claim. Last but not least, for every declination >RM5,000, we will need to present and get the approval from our Chief Operating Officer which is very tedious because he is our top management and that's the reason we don't decline case without solid proof. Whereas approving a claim is so much easier.

I think it would be fair for both Insurer and Insured if you explain the whole situation in detail especially for the mass market. If you need help in fighting for your claim, do let me know your policy number, I'm sure I will be able to help you if your case is genuine.

Hope your appeal will be accepted.

Please do update and hope all is well for you.

When u are better, please do give us more details

God Bless

I bought GE since 1994 (36 illness) and til Jun 2013, my agent came and approached me to upgrade my policy. Unfortunately, I diagnosed with LEFT breast cancer in May 2014. Now, they reject my claim due to the reason of "UNDISCLOSED" because they said I never disclose that I did my yearly medical check since 2001 and found I got a small cyst on my RIGHT breast. Frankly speaking, since 2001 - 2014, doctor did not comment anything on my cyst found in RIGHT breast but just advice to do yearly check up as usual. Also, my LEFT breast is normal at that time (last medical check on JAN 2014). I wrote an appeal letter and explained but still they insisted I did not disclose the "cyst found on my right breast" upon signing of the upgraded policy in Jun 2013. How do I know I have to mention about it although my doctor did not comment anything special on it????? I don't understand.....it's unfair to me.

Now they reject my appeal again by giving the same reason "UNDISCLOSED", at least they have to call me up and let us sit together and talk about it (I think). Otherwise, their final judgement means final, as an insurer, we have to accept.....is it????

I think the last step I could do is go to BNM and appeal. Just wanted to know, can I hire a lawyer to sue GE on this?

I really do not know what to do now. I am very frustrating. As a cancer patient, the compensation and medical coverage is very important to me, but now, all gone. I feel very disappointed with insurance, I trust GE for more than 20 years but at the end, it's useless to me. What's the point????

Appreciated if anyone can assist me by giving your advice here.

I bought GE since 1994 (36 illness) and til Jun 2013, my agent came and approached me to upgrade my policy. Unfortunately, I diagnosed with LEFT breast cancer in May 2014. Now, they reject my claim due to the reason of "UNDISCLOSED" because they said I never disclose that I did my yearly medical check since 2001 and found I got a small cyst on my RIGHT breast. Frankly speaking, since 2001 - 2014, doctor did not comment anything on my cyst found in RIGHT breast but just advice to do yearly check up as usual. Also, my LEFT breast is normal at that time (last medical check on JAN 2014). I wrote an appeal letter and explained but still they insisted I did not disclose the "cyst found on my right breast" upon signing of the upgraded policy in Jun 2013. How do I know I have to mention about it although my doctor did not comment anything special on it????? I don't understand.....it's unfair to me.

Now they reject my appeal again by giving the same reason "UNDISCLOSED", at least they have to call me up and let us sit together and talk about it (I think). Otherwise, their final judgement means final, as an insurer, we have to accept.....is it????

I think the last step I could do is go to BNM and appeal. Just wanted to know, can I hire a lawyer to sue GE on this?

I really do not know what to do now. I am very frustrating. As a cancer patient, the compensation and medical coverage is very important to me, but now, all gone. I feel very disappointed with insurance, I trust GE for more than 20 years but at the end, it's useless to me. What's the point????

Appreciated if anyone can assist me by giving your advice here.

Firstly very sorry to hear of your diagnosis, hope that you will get well soon. I believe you have rather a strong case here because a cyst in 2001 may not be related to cancer in 2014. Furthermore, your policy was bought way back in 1994 when the cyst was non existent then.

Suggest to write to Financial Mediation Bureau which is stated in the decline letter sent to you.

They are rather unbiased. Good luck.