Hi thank you guys for the reply.

I have actually read the policy thoroughly after the incident.

According to the policy, the waiting period for the medical card to be fully functional is only 30 days. But I remember the agent however advised to wait until 6 months before using the card, and my case here is after 11months, and hence I feel that it shouldnt cause a problem at all.

The agent, at the time of admission, was out of country and I was unable to contact her. But later after she came back, I have called her and explained the situation. But she seems not really bothered about it, and she was giving all kind of excuses  that she is not feeling well, hence she could not visit my house or the insurance office at the moment. Now I learnt the ugly truth, that some insurance agents are has two face, being nice when they ask us to sign up, but after tat they just ignored us. So please be extra careful when an insurance agent approach you, even when its your friend. Learn from me.

And actually, I have also submitted my complaint to BNM. But the officer at BNM hinted me that most of the time, the client will not get back the premium in cases like this. I was more upset when I heard this. It is very clear that the insurance is being unfair, giving thousands of reasons to decline the GL, yet the BNM officer still saying that like the GL is a value added service and its not a guarantee. Yes I agree, but shouldnt there be a good reason to decline the benefit? How can they can decline the benefit only based on their stupid assumptions. They didnt validate anything, its all only speculation.

This is why I am planning to sue the insurance company as my next step. Appreciate if anybody could point me in the right direction, to find a law firm with minimal consultation and legal fee. I just need my premium back. And to inform as much as people as I can, that Great Eastern Medical Insurance and their customer service sucks. My personal advice, please dont buy medical insurance from this company.    

I understand Felix. Even the GE Officer mentioned the same thing, tat only the GL is declined, and not the claim. He even asked me to pay first and submit the bills for claim.

But is that why we are taking I insurance policy in the first place? I know I take medical insurance for my mother so that incase of emergency like this, she could get admitted in the hospital with no payment or minimal payment. Tat is the reason we are paying the premium. And tat is the attractive feature that all insurance agent mention to client, that when emergency happens, you might no have the money, and which is way medical card is important. My agent gave me the same crap as this and I bought it.

We are paying the premium not because we want the reimbursement, but we want coverage from the beginning of the admission. If reimbursement is wat insurance offer, I believe nobody will take insurance policy.

And the worst part is, they couldn't even give me a proper reason. My mother do not have a medical record related to Colotis, which I know for a fact, and the doctor also mentioned in the diagnosis form, that she I her professional opinion thinks that this is not a pre-existing illness. But the insurance keep giving the pre-existing illness shit and other stupid excuses.

I mean if they suspect this is a pre-existing illness or wat, investigate laa.. I don't stop them. But do it fast in a day it two like tat, not 2 or 3 months for god sake. Stupid insurance. Doesn't really care about their client.

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.

where is ExpZero

he sell great eastern u can ask him

https://forum.lowyat.net/index.php?showtopi...&#entry66189024

ExpZero Summoning.... pls help?

2)If you would like to change another insurance company, the waiting period will start all over again. The SOP of declining GL for less than 1 year for investigation purpose is standard in the industry as my ex-colleague who works in other insurance companies told me.

Sifus-sifus sekalian,

Posted this in insurance talk, and no feedback from others...

I have a problem here with AIA and I would like to get some opinions from policy holders and insurance agents:-

I bought an medical insurance policy for my mother. My mother is kind of old, so the premium is quite expensive, of course before the policy was enforce, a medical screening was done and submitted for approval. 11 months down the road after the policy is enforce, a checkup revealed that my mother has contracted Hep-C.

So in order to do the claims for the treatment, my mom has to be hospitalized for one day and post hospitalization jabs can be claimed. The f*cking problem with the f*cking insurance company right now is:-
- it's been 6 bleeding months and the investigation is still 'going on'...as of now, the the underwritting process is still 'on going'

- the first batch of medical bills (3 months) has been submitted for claims, since I can't get confirmation on the first batch of bills, I wasn't able to do claims for the second batch because hospitalization is required

- I've chased my agent countless of times. She said: "wait, be patient" or..."this needs about 2 weeks to process". This lame excuses has been reused countless of times

- I've completely lost confident in this imbecile agent (who also sold me very lousy medical policy), and I decided to follow up the claim myself with the insurance company. (you just got to do everything yourself...initially, I submitted the claims to her and she said she'll settle for me, I think there's a lot of delaying on her end as well)

- as of lately, the investigator fax a document to my mom, wanting my mother to acknowledge and answered a few questions before proceeding with the underwritting and decison making process. I've fax the document on 2nd November and I was asked to for one week. So today I called in to enquire the status. The customer service clerk check system and told me that the fax document was scanned into the system 4th of Nov, and I need another one week to know the answer!

This
is
f*cking
ridiculous.

I'm very very sorry for the swearing because I'm in a terrible mood...okay guys, here are the questions:-
- If I want to make a complaint to AIA, where should I go? How should I go about? Or I pull MCA thing? (don't think the MCA thing will work though)
- Does it make a difference if I march into AIA HQ and make a big ruckus?
- Can I change my bloody agent?
- Can I lodge a complaint against my agent?

Thanks,
Totally Disappointed with AIA


--------------------------------------------------------------------------------
Added on November 12, 2010, 9:52 amAdditional details:-

Mom went to private hospital for treatment, SJMC. From the day I received the bill. I pass everything to the agent to settle it. But then again, she came to me a couple to get more details, there was historical medical report needed, which clinic went to in the past 5 years or something, etc etc.

From what I found out, Hep-C is something viral that stuck in the body for years...what the investigators are trying to prove now is that my mother contracted hep-c before the policy was bought (insurance doesn't cover pre-existing condition). So for worst case scenario, the investigator might call up clinics and hospital everywhere to get medical record or some sort of prove...which I think they did that, or else, how come the investigation took so long?? This is what agent stated this as a "special case".

As far as I remember, my mother's previous blood test and check ups are all okay (If there was a problem, doctor could have advise or something). Even before the policy was bought, AIA request my mother to do a medical checkup with panel clinic to get report. The panel clinic diagnosis and checkup was simple. No blood test.

Another thing why I'm so pissed off is that, since I've been following up with both my agent and AIA customer care personnel. Both them give me different story every time I ask for claim status. From this incident, I have this stinking feeling that my agent is inexperience at all at doing claim and handling cases. My perception here is that the why would customer care personnel lie?

So sick and fed up.

It has been six months, I tried very hard to pay for the treatment on my own, with claim department delaying the claim for the first batch, I can't claim for the second batch. What has been paid, paid. What I need to know whether AIA can approve the claim or not.

If they are not, I need a very valid reason why. If the investigators can indeed prove that my mom contracted hep-c before she got the policy, fine. Which, I think they can't find any prove yet...I believe the only thing they can speculate that my mother contracted Hep-C years ago was a 'Raised GGT' values found in year 2006 medical report. From what I research, raised GGT is just an indicator of liver damage and it is not valid measurement for Hep-C diagnosis. And if there was raised GGT is a blood report last 2006, the doctor could have probe further. What I afraid the most is whether the investigators are working with speculative facts to reject the claim.

If they are in the 'underwritting' process, make it fast (6 months ler, macha, a typical company/bank/kedai runcit out there probably has already run 2 quarter financial report ler).


--------------------------------------------------------------------------------
Added on November 18, 2010, 3:52 pmAfter long waiting and delayed lame excuses from my imbecile agent, I manage to find out status of my mom's claim. I manage to get insider info from my brother-in-law's agent (from GE, he know the guys working in AIA claim dept.) to probe and get the answer from claim department.

The claim is REJECTED.

THANK F*CK YOU VERY MUCH, AIA. AFTER LETTING ME WAIT FOR 6 MONTHS.

From what the claim department said, they reject the claim because of the Raised GGT levels found in the blood test that was done in 2006. From what I research, raised GGT is not a definite indicator of hepatitis, but an indicator of liver damage (they are a couple of reasons that cause this).

I will chase for an official reply from AIA AND I'm going to go for appeal. If there was a problem with my mother's blood test 4 years ago, the doc could have probe further that time.

My guest is correct when they are working on speculative facts to reject my mother's claim. This AIA is the MOST F*CKED UP insurance company that I've come across...SAME GOES FOR THIS AGENT 'FRIEND' OF MINE.

bro, if let say someone change/upgrade their medical card plan after 1 year, GE will still decline the GL for investigation purpose?

Hi Exp Zero,

Thank you for your reply. Really appreciate it.

But why the SOP is not being made aware to the client? It is never mentioned in the policy or by the agent that cases within 1 year time will require stupid 2 to 3 months investigation. Why it is never mentioned to the client? It is not even in GE policy. If they have mentioned that, I have made a better decision not taking this stupid insurance that do investigation for 2 to 3 months. This is a medical necessity and waiting for 3 months is really not rational at all.

And why I need to pay first when I'm having the medical card? I should be enjoying the GL benefit, unless there is a valid reason like for example my mother case falls into any of the exclusions. That I really can accept.

But now there any giving excuses like they are no sure, and there is not enough information. What in supposed to do if there is not enough information? I have forwarded all the documents given by the doctor. So now GE except clients to do research and find out information regarding the illness before admission to the hospital. What the hell? When they are selling, none of this were mentioned either by the agent or in the policy.

Really, based on my experience, GE is being unethical and biased. They don't really care about their client. Their so called SOP sucks, and client is not even made aware of that. Please don't choose GE, if you want your life really assured.

I really want to terminate my mom's and my policy with the company. Just tat I want my money back,  but the stupid company dowaan to give back my money. I mean I never have claimed nything from them, so it is fair enough for me to get me back my money, but this the company said can't give. Blood suckers. Wants people money, but not giving them wat they deserve.

Truely agree. I also piss off with GE agent. If there is any reputable insurance company that allow customer to purchase insurance via online, i'm very very much interested and terminate my lousy insurance policy!

Example is fundsupermart to allow customer to buy unit trust via online and bypass unit trust agent!

End of the day, Great Eastern is lousy insurance company. What do you expect from Singaporean company? They all just want to take your premium but not pay when you claim. So many people I know complain about the same thing with Great Eastern.

I think last time even their staff also complained and had street protest and demonstrations outside their HQ in Jalan Ampang? Any company where the staff have picket demos and complaints can't be good. MAS last time also the same and look at it now.

better wait for the investigation result.

if the result is not in ur favor then only terminate

I have never believe in any part of the insurance selling which basically say that a medical card will get you admitted into a private hospital.

The most tangible entrance fees for admission that a private hospital look to is credit-card or cold hard cash. Insurance medical card really is second rated.

Besides, I heard that it is common practice that private hospital bump up the charges when they deal with insurance claim vs a cash paying customer. This could also draw down the insurance claim limit faster than necessary.

TS, in your case, you could always pay first for the private hospital, and claim back later. If you have beyond reasonable doubt that it is not an existing pre-condition, GE cannot deny you your claim down the road. You could always decide on cancelling the insurance AFTER the claim if GE did not serve your needs and expectation.

ExpZero you are not telling the entire story, especially for your own Great Eastern company. The protest I am referring to is the one involving Menara Great Eastern on Jalan Ampang and you deflect to Miri???

This is just showing everyone how a Great Eastern agent works, not telling the entire story and selective in sharing information.

Enough said, you have just shown everyone that your actions is the same as what your Great Eastern company do to its policyholders.

Hi Exp Zero,

Thank you for your reply. Really appreciate it.

But why the SOP is not being made aware to the client? It is never mentioned in the policy or by the agent that cases within 1 year time will require stupid 2 to 3 months investigation. Why it is never mentioned to the client? It is not even in GE policy. If they have mentioned that, I have made a better decision not taking this stupid insurance that do investigation for 2 to 3 months. This is a medical necessity and waiting for 3 months is really not rational at all.

And why I need to pay first when I'm having the medical card? I should be enjoying the GL benefit, unless there is a valid reason like for example my mother case falls into any of the exclusions. That I really can accept.

But now there any giving excuses like they are no sure, and there is not enough information. What in supposed to do if there is not enough information? I have forwarded all the documents given by the doctor. So now GE except clients to do research and find out information regarding the illness before admission to the hospital. What the hell? When they are selling, none of this were mentioned either by the agent or in the policy.

Really, based on my experience, GE is being unethical and biased. They don't really care about their client. Their so called SOP sucks, and client is not even made aware of that. Please don't choose GE, if you want your life really assured.

I really want to terminate my mom's and my policy with the company. Just tat I want my money back,  but the stupid company dowaan to give back my money. I mean I never have claimed nything from them, so it is fair enough for me to get me back my money, but this the company said can't give. Blood suckers. Wants people money, but not giving them wat they deserve.

Great eastern medical card is "As charged" or "As charged subject to reasonable medical fee" ?

How to find the price of the medical cost for the GE as charged price list?

Truely agree. I also piss off with GE agent. If there is any reputable insurance company that allow customer to purchase insurance via online, i'm very very much interested and terminate my lousy insurance policy!

Example is fundsupermart to allow customer to buy unit trust via online and bypass unit trust agent!

Some Insurance Companies have Bancassurance Partnerships with Banks, meaning u can buy selected Insurance Products at Banks, and sometimes, the products are priced lower compared to Agent products

Great Eastern - partners OCBC
Prudential - partners Stan Chart and UOB
AIA - Partners Public Bank (due to former agreement with ING)
Tokio Marine - Partners RHB Bank
Sun Life - Partners CIMB

Bank owned Insurance Compaies

Etiqa - Maybank
HLA - Hong Leong
AmLife - AmBank
AXA Afin - Affin Bank

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.

         

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.

May be I din stated clearly. Actually they have settled (paid) the policy which I bought in 1994. The one that declined was the upgraded policy which entered in may 2013. But based on the info I mentioned above, I felt like being cheated.

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

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.

May be I din stated clearly. Actually they have settled (paid) the policy which I bought in 1994. The one that declined was the upgraded policy which entered in may 2013. But based on the info I mentioned above, I felt like being cheated.

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.

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.

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.

EXACTLY RIGHT!  AGREED!

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!

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.

In the end, they still get certain claim right? To me, insurance isn't perfect but still a formidable risk management you need as third-party (as a policy owner) that is.

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 a strong believer of having sufficient or rather more than sufficient insurance in one's life and this coverage should move upwards or downwards accordingly to the changes in one's life and earning capability. Somehow, I do agree with the caliber and integrity of most insurance agents in Malaysia sucks big time as I personally witness how a young lady who just joined the industry keep insisting me to get my investment link policy way beyond what I can afford and after which, I realized she did that because she is trying to hit some target set.

Nonetheless, like all industries, there are the bad rotten apples, at the same time, there are the good and honest one. I am glad I have found one. Trust me when I said I am a good reader of insurance agents as I have seen far too many. From my days in London to Singapore to now Malaysia. First time in my life my insurance agent advise me against buying 3 policies from her in one go as she find that the financial impact on me will be great and advise me accordingly which one to go for first and subsequently slowly up the ante.

After reading 4-5 pages of this thread I happened to come to a conclusion which I guess not many will agree as well. Insurance company is just another business entity operating for the sake of profit generating, well even the hair saloon you cut your hair is operating for money. One day when you realised your hair style done by the hair saloon is not as good, will you ask for  your money return and go around telling everyone that the hair saloon cheated your money etc? My guess is no and why is that so? The business model is almost identical, Hair saloon is making money out of you by providing a service to you and hair stylists are like agents bridging the market gap between you and the hair saloon. There are good hair stylist and there are bad one, so when you happened to find one good one. Please stick to him/her and frankly speaking, it is of no fault from the company point of view.

At the same time, I find insurance knowledge from majority Malaysians is severely lacking (applies to agents as well) Many have no idea when to make known their medical condition to the insurance company and when things happened, they start calling for the head of the insurance companies. Hey com'on, if you were to buy a used car and after taking the car out of the dealership, immediately the engine dies off. Would you blame the dealer for not telling you the existing problem with the car? Or would you take full responsibility and pay for repair on your own? Metaphors are all around us just that due to the lack of sufficient insurance coverage knowledge, many are led by the nose of their "trusty" insurance agents and omit declaring or under declare their existing or known condition which eventually haunted them.

I read all policies given to me before I sign the acknowledgement slip. I declared all medical conditions regardless how mild or insignificant it is (even my agent commented how detail I am). I even have a full discussion with the panel doctor when I go for my check up. When I need to make a claim, I always call my agent up and get her to advise me on what to say and what to do when I see the doctor. I noticed many times people tends to downplay their condition in front of doctor which eventually caused the medical report issued by the doctor to completely downplay your condition as well. This eventually become your problem when you want to process a claim.

Currently I holding 3 policies and each is around 30% above my expected payout because I like to be sure that my family is well taken care of if something bad happened to me. So far, I feel GE has been quite professional in dealing with my case as even for my generic skin condition - eczema, they requested previous medical report from my GP in Singapore.

If anyone stated that they do not need any insurance policy, I really do hope you earn much much more than the rest of us and yet have much much less commitment than the rest of us. Oh ya, please at least ensure your car is insured, why? Because if you accidentally bumped into mine, I will like to claim from your car insurer. At least that is protection I expect to have as a fellow road user. Protection for your family remains your personal call. I pray for good health and great life to you if you decided not to be insured.

I am a strong believer of having sufficient or rather more than sufficient insurance in one's life and this coverage should move upwards or downwards accordingly to the changes in one's life and earning capability. Somehow, I do agree with the caliber and integrity of most insurance agents in Malaysia sucks big time as I personally witness how a young lady who just joined the industry keep insisting me to get my investment link policy way beyond what I can afford and after which, I realized she did that because she is trying to hit some target set.

Nonetheless, like all industries, there are the bad rotten apples, at the same time, there are the good and honest one. I am glad I have found one. Trust me when I said I am a good reader of insurance agents as I have seen far too many. From my days in London to Singapore to now Malaysia. First time in my life my insurance agent advise me against buying 3 policies from her in one go as she find that the financial impact on me will be great and advise me accordingly which one to go for first and subsequently slowly up the ante.

After reading 4-5 pages of this thread I happened to come to a conclusion which I guess not many will agree as well. Insurance company is just another business entity operating for the sake of profit generating, well even the hair saloon you cut your hair is operating for money. One day when you realised your hair style done by the hair saloon is not as good, will you ask for  your money return and go around telling everyone that the hair saloon cheated your money etc? My guess is no and why is that so? The business model is almost identical, Hair saloon is making money out of you by providing a service to you and hair stylists are like agents bridging the market gap between you and the hair saloon. There are good hair stylist and there are bad one, so when you happened to find one good one. Please stick to him/her and frankly speaking, it is of no fault from the company point of view.

At the same time, I find insurance knowledge from majority Malaysians is severely lacking (applies to agents as well) Many have no idea when to make known their medical condition to the insurance company and when things happened, they start calling for the head of the insurance companies. Hey com'on, if you were to buy a used car and after taking the car out of the dealership, immediately the engine dies off. Would you blame the dealer for not telling you the existing problem with the car? Or would you take full responsibility and pay for repair on your own? Metaphors are all around us just that due to the lack of sufficient insurance coverage knowledge, many are led by the nose of their "trusty" insurance agents and omit declaring or under declare their existing or known condition which eventually haunted them.

I read all policies given to me before I sign the acknowledgement slip. I declared all medical conditions regardless how mild or insignificant it is (even my agent commented how detail I am). I even have a full discussion with the panel doctor when I go for my check up. When I need to make a claim, I always call my agent up and get her to advise me on what to say and what to do when I see the doctor. I noticed many times people tends to downplay their condition in front of doctor which eventually caused the medical report issued by the doctor to completely downplay your condition as well. This eventually become your problem when you want to process a claim.

Currently I holding 3 policies and each is around 30% above my expected payout because I like to be sure that my family is well taken care of if something bad happened to me. So far, I feel GE has been quite professional in dealing with my case as even for my generic skin condition - eczema, they requested previous medical report from my GP in Singapore.

If anyone stated that they do not need any insurance policy, I really do hope you earn much much more than the rest of us and yet have much much less commitment than the rest of us. Oh ya, please at least ensure your car is insured, why? Because if you accidentally bumped into mine, I will like to claim from your car insurer. At least that is protection I expect to have as a fellow road user. Protection for your family remains your personal call. I pray for good health and great life to you if you decided not to be insured.

Well written. Don't mind if I can quote your statement in the near future ?

I am a strong believer of having sufficient or rather more than sufficient insurance in one's life and this coverage should move upwards or downwards accordingly to the changes in one's life and earning capability. Somehow, I do agree with the caliber and integrity of most insurance agents in Malaysia sucks big time as I personally witness how a young lady who just joined the industry keep insisting me to get my investment link policy way beyond what I can afford and after which, I realized she did that because she is trying to hit some target set.

Nonetheless, like all industries, there are the bad rotten apples, at the same time, there are the good and honest one. I am glad I have found one. Trust me when I said I am a good reader of insurance agents as I have seen far too many. From my days in London to Singapore to now Malaysia. First time in my life my insurance agent advise me against buying 3 policies from her in one go as she find that the financial impact on me will be great and advise me accordingly which one to go for first and subsequently slowly up the ante.

After reading 4-5 pages of this thread I happened to come to a conclusion which I guess not many will agree as well. Insurance company is just another business entity operating for the sake of profit generating, well even the hair saloon you cut your hair is operating for money. One day when you realised your hair style done by the hair saloon is not as good, will you ask for  your money return and go around telling everyone that the hair saloon cheated your money etc? My guess is no and why is that so? The business model is almost identical, Hair saloon is making money out of you by providing a service to you and hair stylists are like agents bridging the market gap between you and the hair saloon. There are good hair stylist and there are bad one, so when you happened to find one good one. Please stick to him/her and frankly speaking, it is of no fault from the company point of view.

At the same time, I find insurance knowledge from majority Malaysians is severely lacking (applies to agents as well) Many have no idea when to make known their medical condition to the insurance company and when things happened, they start calling for the head of the insurance companies. Hey com'on, if you were to buy a used car and after taking the car out of the dealership, immediately the engine dies off. Would you blame the dealer for not telling you the existing problem with the car? Or would you take full responsibility and pay for repair on your own? Metaphors are all around us just that due to the lack of sufficient insurance coverage knowledge, many are led by the nose of their "trusty" insurance agents and omit declaring or under declare their existing or known condition which eventually haunted them.

I read all policies given to me before I sign the acknowledgement slip. I declared all medical conditions regardless how mild or insignificant it is (even my agent commented how detail I am). I even have a full discussion with the panel doctor when I go for my check up. When I need to make a claim, I always call my agent up and get her to advise me on what to say and what to do when I see the doctor. I noticed many times people tends to downplay their condition in front of doctor which eventually caused the medical report issued by the doctor to completely downplay your condition as well. This eventually become your problem when you want to process a claim.

Currently I holding 3 policies and each is around 30% above my expected payout because I like to be sure that my family is well taken care of if something bad happened to me. So far, I feel GE has been quite professional in dealing with my case as even for my generic skin condition - eczema, they requested previous medical report from my GP in Singapore.

If anyone stated that they do not need any insurance policy, I really do hope you earn much much more than the rest of us and yet have much much less commitment than the rest of us. Oh ya, please at least ensure your car is insured, why? Because if you accidentally bumped into mine, I will like to claim from your car insurer. At least that is protection I expect to have as a fellow road user. Protection for your family remains your personal call. I pray for good health and great life to you if you decided not to be insured.

Go ahead, I claim no credit for the write up as I am just sharing my personal view on insurance coverage. Really puzzle with some claiming they do not believe insurance and yet when they buy a house, they insure the house, they buy a car, they insured the car. I was a victim of an accident to the back of my car and the fellow does not have insurance. I am so tempted to report him to the polis and sue the hell out of him as he is so irresponsible.

If you are asking me, I will tell you straight in the face, those who claim they do not buy insurance as they do not trust insurance are really irresponsible. At least to their family. Asian valued our family ties as top priority and many parents claim how much they love their children, giving the best to them. However, they refuse to even buy a RM200 medicard for their children and prefer to spend the money on better car, expensive handbag or even an expensive dinner. I really confuse.  Read a statement which I really find very meaningful for parents who do not insure their children medical to dwell over. "If the child fall sick and after spending millions of ringgit to save the child, yet the young life passed on, the father and mother will definitely feel sad, however they will get over it and move on. If children fall sick and yet passed on because the father and mother did not have enough money to save the child. There is no way they will be able to get over it and forgive themselves"

How many times we read online / facebook about how someone is dying and require donation from public because their relatives are so heartless to ignore their pleas. I used to donate money to these unfortunate group until I realised there are many Malaysians bearing same thought and belief like how some in this threads are functioning. They ignore their life insurance coverage thinking they are still young, healthy, no money, not trusting insurance etc..... and yet when shit happened, they scramble around their relatives, friends and closed ones for money and starts criticise how heartless these people are when they refuse to loan them the hundreds, thousands and more. Then they resort to going online to "beg" for donations and naive people like me in the past so willingly open our wallet and take out 100 so that the tiny amount can accumulate to the medical fee which should be originally covered by insurance.

I earn my 100 the hard way as well and being responsible for myself, I still have to take care of those who refuse to take responsibilities for themselves? Now I choose to be "heartless" because a pitiful person sometimes really deserved it. You can disagree with me, at least I know if there is anything to happen to me, I leave behind more than million for my wife and parents and if I need treatments, I can go to the best hospital with the best doctors and best facilities, while you who is not insured can only wept pitifully at how your loved ones go around begging for money and yet faced rejection day in and day out because of your irresponsible decision for ignoring insurance.