Okay, that makes things much clearer.

Normally for say such disease like Cancer, getting t within 1-year of Purchase of an Insurance Policy will trigger many investigations by the Company as to whether you really knew that you were sick or was already a pre-condition, meaning it was really existing and you may or may not have known about it.

Since GE has already honored the previous policy in 1994, my personal opinion is that its going to be tough for you to fight for GE to honour based on the new policy.

You will really need some sort of supporting letters from your current doctor that in May 2013, when you bought the upgraded policy, you were not aware of the condition or your condition was non-existent.

Try to talk to your current doctor and see if they are willing to help you draft somethings along those lines.

Nay you have a speedy recovery

According to my yearly medical report from 2001 ~ 2014, doctor NEVER mentioned about special treatment or alert on my cyst but just do yearly check up as usual. I believe GE will receive the same reports as mine. Right? Even doctor cannot justify it is a cancerous cyst, and no further check up or screening are adviced.

Another thing is, I was sent by company to do yearly check and the doctors are different every year. So, whIch doctor they are referring to?

I think no need to talk to doctor as he/she already gave me their conclusion n advice in my medical reports unless they are giving different statement to GE.

Can we call GE n request for the proof? Or can I request an interview with claim dept?

Few points to question... All these could be due to laziness of agent as well

1) when you say upgrade, i assume you actually mean a new policy. Always in insurance form they will ask about medical check up and results, if any. Now this has not been disclosed to insurance company. So, even if you were not aware of your condition, you did fail disclose about those medical check up.

2) and you mention doctors giving advice? You mean those check ups or what? Abit confused. If those medical check up is company related, got nothing to do with GE?

Sorry for your illness... Hope you gain a full recovery soon.

(1) I think the upgrade is "top up" by giving a new policy number. I'm not is this a normal practice. But 1 thing for sure is according to my agent, medical check is required by insurance company only if the premium is very high and mine one not necessary to do the check.

(2) you are right, the medical check is a routine (yearly) check which required by my employer. Ever since I diagnosed with cancer (May 2014), GE did investigation and they got the results from my company panel doctor. As doctor said I'm healthy and no special treatment or further diagnosis test is needed, so I really never take it as a big deal. In this situation, how do I justify whether I should tell?

FYI, the cyst found in 2010 is on my RIGHT breast, now the cancer is on my LEFT breast.

The upgraded policy was it upgraded from an old policy or was it a new policy all together but comes with better benefits? If it 'upgraded' from an existing old policy, then let's look at the date on which it was first bought.

If it is an entirely new policy bought in May 2014, then we are looking at a condition of cyst appearing since 2001 discovered during a routine annual check up. Few points you can raise here:

1. Whether the cancer arises from the cyst itself or not. If not, then you can argue that the cyst has nothing to do with the cancer because the location is different.

2. Since the cyst has already been discovered since 2001, and there has been no change ever since, and at time of you signing up the application in May 2014 it was still a cyst, why would that be unusual?

Of course technically, we should have answered the questions in the application form accurately so that the Underwriters can assess the application form correctly.

Again you can still bring this case up for mediation with the Financial Mediation Bureau which is authorised by BNM.

Good luck!

Best wishes for a speedy recovery TS!

I do not have any vested interest on the outcome of the claim either way, but with your permission, I would like to share my 2 rupiah opinion.

The summary of it is that I do not think the claim on the 2013 policy would be successful.

Insurance is a contract- nothing more, nothing less. So let's have a quick look at the components of a contract. There is the buyer/proposer, the seller/acceptor and consideration which is something of value, in this case the monetary insurance premium that the client would be paying.

One of the main difference of a insurance contract compared to other contracts, is that it is a contract of uberrimae fidei in latin which means utmost good faith. So the client is supposed to declare their health in full, to the best of their knowledge in good faith to the insurance company. The insurance companies then decide should they want to accept this proposed insurance, decline or impose any special condition to it.

By not declaring the medical condition (cyst) even though knowing about it and with doctor's acknowledgement of its existence is a breach of contract of utmost good faith. Whether or not it is a top-up policy with the same policy number or an entirely new policy is not relevant because the condition existed prior to the policy being entered in 2013 (pre-existing condition). The exception here is that companies may at certain times make an explicit waiver for health requirements declaration for certain periods or certain products (i.e. senior citizen life coverage that do not require medical check up).

The next question that may arise is that the cyst was on the right breast, whereas the cancer was on the left breast. So in tandem with the non-declaration of a pre-existing condition, we now look at whether this is a material fact. A material fact is defined as one that would make an underwriter make a different decision. Some definitions go as far as to term it 'prudent underwriter'.

If the client had disclosed the existence of the cyst when taking up the policy in 2013, would the underwriter decline the case? Would the underwriter request for a medical check up at their panel clinic? Would they impose a loading term? Would they exclude breast coverage?

We wouldn't know, but the choice of declaration is not within the scope of the client nor the agent to determine. The client is supposed to declare and let the underwriter make the decision. In that case, even if case was mistakenly approved, the burden of proof and claim then rests with the insurer and not with the client as is the case now.

The small silver lining is that the insurer would need to refund the premiums paid since 2013. You may still opt to write in to appeal based on compassionate grounds but the chances wouldn't be very high.

Once again, i wish you good health and a speedy recovery and i'm sorry i could not give you a brighter reply to your claim.

First of all, thank you very much for your reply.

I really confuse, I did informed my agent all those information including I am a thalesimia carrier, but he told no need to declare anything on it. So, as a general public, I buy insurance from an appointed agent by GE, of course I have to trust him, what is wrong with me? GE is suppose to investigate on the quality of their before making any judgement on it.

Now, one of my child also a carrier of thalesimia, but with agent's advice, we did not declare it to GE. So, what shall I do next?

Since agent who is so called "TOP agent" of GE cannot be trusted, what shall I do??

I hope to make as a big issue so that everyone will be alert. Previously, none of my family members believe in insurance except me, I'm the one who approaching them by telling them how important the insurance is especially when we need. But now, seems I'm totally wrong.

I know it's not a wise decision to cancel all my family members insurance now, but really get mad with GE ...... they are lier......they cheated n keep cheating by their agent. Any advice on this?


This post has been edited by AL0716: Jan 9 2015, 03:10 PM

Find an honest agent. Although that’s not easy to come by. Insurance companies abide by the contract and usually not out there to cheat customer's money. You must understand insurance companies also can't have customer lying to get money from insurance companies. After all, we hope the money paid by insurance companies, really go out to deserving individuals.

The irony is TOP agent doesn’t mean the best. It means this agent brought in a lot of sales. After all, their priority is closing sales. The bigger the better. The faster, the better. A proper agent would have sat down asked the customer each question in the proposal form, ensure the customer understand the questions in it and made sure everything that needs to be disclosed was indeed disclosed so that we don’t have this non-disclosure problem.

And please don’t cancel any insurance without thinking through.

Yes, MAY BE you are correct in the way that insurance company didn't cheat their client but one thing for sure is they make use of the relationship as well as trust between agent and clients to get more business but they will make as much trouble as possible when we really need them. When comes to claim, most of the people will say it's agent's fault, meaning..........none of the business for the insurance company.

I did provide many proofs that I have no intention at all to cheat them. If I want to, I shall upgrade my insurance when my cyst was found in year 2011. Why should I wait until my agent propose me to upgrade in 2013????? Can anyone explain to me on this???

I really hope their claim department will call me up for an interview, I got many questions and many things that need to voice out. To GE, declined means declined by issuing a notification......that's all.

To me, my agent is a honest agent until now. He is still doing whatever he can to appeal for me. But on the other hand, he is not because he made me in trouble now. SO, how to judge / find a honest agent??



This post has been edited by AL0716: Jan 9 2015, 05:19 PM

EXACTLY RIGHT! AGREED!

SO, think again before want to buy insurance.

I am truly grateful for this thread. Being a one year old agent of Great Eastern now I realise why many of my Group Managers are giving different opinion in terms of disclosing customer information to the underwriter. The more it is disclosed, the longer it will take for the policy to get inforce (passed birthday may subject to increase premium). The more it is disclosed, the possibility of customer being loaded and being declined is higher.
Conclusion, the more it is disclosed, the higher chance that we will loss the sales.
Thus, like every other sales in the world, the fine line is always between sales first or SOP first.

To be honest, I want to be a high integrity insurance agent, but being a new agent under so many 10 plus years seniors opinion which mostly are siding more on the sales, I have somewhat decided to just take it easy when disclosing information. The mind is telling, most important is to get it inforce since sales is not easy to comeby, other thing later decide (belakang kira).

After going through this thread, I think I have no choice but to change my mind about this. I will rather loss the sales than seeing a friend or a relative who is sick but not getting paid from the insurance company.

It is super sad thing to see that while they are sufferring from illnesses and the product that we are selling suppose to help them did not help.


AL0716: So sorry to hear whatever happen to you. I really dunno what to comment. But only hope you will really take good care of yourself! Your case has definitely help me to know what to do in the future. Thank you so much.

Those insurance agency really needs to emphasize on the ethics of their agents. One part time GE agent (who working in the biggest low cost carrier ancillary department) keeps persuading my friends to top up current plan and new package that he does not need.

A really poor and insincere agent.

This is their SOP, cheat and mislead to earn a luxury living.
If a person that has ethics, they won't be an insurance agents.

yup, heard my friend said, the person (the name shld be Jojo) did a lot of plots to try to climb onto higher ladder in the aviation company. Not to mention the plots he did in insurance industry. He always mention himself as Christian in order to convince ppl that he is a sincere man. LOL

As said before, under this industry, if you don't cheat and mislead but telling the fact, out of 10 person you meet, all won't buy

That doesn't sound like it. Unless the customers are the one whose trying to "cheat". Insurance company is more like a risk management company so it is as good as you don't need to worry but certain claims come fast and some come slow.

Yes, you are right, all the time is customer trying to cheat insurance companies, not the other way round

I agree that those less known insurance company might be the "customer" your talking about. Then again of course, rejecting claims because some customers are actually trying to cheat and fake things around is prohibited. I'm stating based on the set of rules either way.

Another case would be "expecting too much" from insurance is part of another factor. Of course, no companies are perfect so expect many critics everywhere!

This post has been edited by sniperz: Jan 20 2016, 09:12 PM

Basically a doctor knows what needs to be written on the report, is just that insurance companies will look for excuse to deny a claim especially when the claim are > amount you paid.
Like my friend had dengue last year, they got rejected due to my fault on sending them to third party lab to do blood test which confirmed dengue positive. Their medical card only cover rm50 for overnight hospital stay and private hospital they went needs rm200 excluding others. The agent are their relative
End up they have to go to GH and stayed for 4 days.