How many of us are actually given the opportunity to go through the entire document before we sign? It's the same in Malaysia for SPA, will, loan agreements, etc.

Background:
I was a non-believer in insurance, mostly due to the aggressive way it's sold, up until I was 30 years old. Then a friend became a Prudential agent and I bought a medical card to support him, which also included life and critical illness protection, and very minimal investment.

Then I started freelancing and also bought a house and a car, so I thought of increasing my insurance - in case something happened to me, the insurance would pay off the loans. Still having doubts about the ethics of insurance companies, I decided to buy extra life and critical illness protection from Great Eastern this time to "diversify the risk".

Over the years, I increased my insurance protection and also bought insurance, including a 15-year education savings which I regret, for my 2 sons. I also started a company that grew to almost 100 people and have been buying company group insurance from Great Eastern - paying a premium of about MYR 70,000 a year.
Critical Illness:
Last year, I was diagnosed with a heart condition that was covered under the critical illness insurance. Due to my fitness level, I was able to undergo non-invasive keyhole surgery (more advanced, less painful, recover faster, smaller scar) to repair my heart, instead of the conventional open-heart surgery where they saw your chest bone and open up your chest.
Claims:
Upon discharge, I submitted all the neccessary reports and documents to both agents and on the SAME DAY. This was what happened:

Prudential
- the agent told me Prudential will respond within 14 working days.
- within that period, Prudential sent me an SMS saying the claim was successful.
- the money was paid into my bank account 2 days later.

Great Eastern
- the agent said don't know how long the process will take.
- a week later GE asked for "certified" docs, which were copied and submitted by their own agent.
- a week later, I was asked to complete a questionnnaire, including which other insurance company I bought from.
- then my claim got rejected.
- GE says based on the policy, I MUST undergo an open-chest surgery to qualify.

My agent was stunned and my cardiologist literally said "what the fuck?". My agent appealed and got rejected - twice. Finally, I wrote a long email to express my disappointment and detailed my entire journey with GE, comparing it with Prudential. My email was escalated two levels up ...and then NO REPLY for a whole month.

Then my surgeon wrote another report and appealed to them. Finally, my claim was approved but GE proudly emphasized that they were ONLY doing it out of goodwill.

I promptly terminated and switched my company group insurance to Prudential. I also did the same with my son's insurance.
Buyer Beware:
It's companies like GE the reason why I never trusted insurance companies. Even my insurance agent who had been selling GE for 13 years was unaware of such a clause, hidden in the fine print.

The insurance policies are supposed to cover us until 100 years old. So between now and then, if there's a new and more advanced medical treatment, we still can't use it because it's not covered under GE's archaic policy?

Over the 13 years, my insurance agent has sold over 500 policies. But including mine, he has only made 3 CLAIMS for critical illness/life to date!

Other issues that I had with GE, was with their online access which didn't work and customer support which takes a minimum of 3 business days to respond, e.g. "we will transfer your request to the relevant department". Seriously? In this day and age of Internet speed? In my last interaction with them, they took 1.5 MONTHS to reply "due to sudden surge of volumes of email" (I wonder why), by which time I'd totally given up.
Conclusion:
Be careful when buying insurance - it's easy to buy but difficult to claim. Based on my personal experience, I would highly recommend Prudential instead (for now). The PruWaiver that I bought meant my son's premium will now be borne by Prudential. My premium will also be borne by them and paid towards my cash value until my policy expires at 100 years old.

I suspect the reason why Prudential paid and the other insurer rejected the claim is that your CI with Prudential is still on the old contract whereby key hole surgery is not mentioned in the heart bypass CI definition.

If you have the Prudential policy, you can snapshot it to confirm.

CI dispute happens a lot in the year 2000-2006 as there isnt a standardised CI definition. A claim in insurer A is approved but rejected by insurer B due to this.

This is why in 2005 (or 2006?) BNM gives a standardized list of CI to be implemented across the industry to avoid confusion.

You mentioned that you had also switch your son's policy to Pru, you may confirm that under the new definition for the heart bypass, keyhole surgery is not covered.

Yes I am a Prudential agent

I suspect the reason why Prudential paid and the other insurer rejected the claim is that your CI with Prudential is still on the old contract whereby key hole surgery is not mentioned in the heart bypass CI definition.

If you have the Prudential policy, you can snapshot it to confirm.

CI dispute happens a lot in the year 2000-2006 as there isnt a standardised CI definition. A claim in insurer A is approved but rejected by insurer B due to this.

This is why in 2005 (or 2006?) BNM gives a standardized list of CI to be implemented across the industry to avoid confusion.

You mentioned that you had also switch your son's policy to Pru, you may confirm that under the new definition for the heart bypass, keyhole surgery is not covered.

Yes I am a Prudential agent

My two medical cards were purchased in 2004 and 2012 respectively.

I did not go for heart bypass. Mine's valve repair via keyhole surgery for mitral valve prolapse.

And that's precisely my point... how can you sell a policy that's supposed to last for 60 years but limit the methods used to out-dated treatments? The surgeon obviously chose keyhole surgery because it's the more advanced method. And acccording to my cardiologists, only 2 hospitals have such experienced surgeons - IJN and Universiti Hospital.

Should the insurance company ethically define the method used? They're after all an insurer and not medical consultants.

I bet most agents still sell critical illness cover as "we'll pay if you get any one of the 36 or 42 critical illnesses", right? They don't say "only after treatment and only if you used specific methods". If you disclosed this, do you think your customers will buy the insurance?

My two medical cards were purchased in 2004 and 2012 respectively.

I did not go for heart bypass. Mine's valve repair via keyhole surgery for mitral valve prolapse.

And that's precisely my point... how can you sell a policy that's supposed to last for 60 years but limit the methods used to out-dated treatments? The surgeon obviously chose keyhole surgery because it's the more advanced method. And acccording to my cardiologists, only 2 hospitals have such experienced surgeons - IJN and Universiti Hospital.

Should the insurance company ethically define the method used? They're after all an insurer and not medical consultants.

I bet most agents still sell critical illness cover as "we'll pay if you get any one of the 36 or 42 critical illnesses", right? They don't say "only after treatment and only if you used specific methods". If you disclosed this, do you think your customers will buy the insurance?

So what exactly is the reason it is now not accepted just because BNM specifically didnt mentioned about the new procedure?
What if there are newer procedure later? wait for BNM to state out too?
Btw i was wondering how come didnt wait for GL approve before doing the procedure? If hospital did contact insurer im sure they will list out what are the procedures going to be done and insurer would reject it and hospital would have to inform you.

...............
Btw i was wondering how come didnt wait for GL approve before doing the procedure? If hospital did contact insurer im sure they will list out what are the procedures going to be done and insurer would reject it and hospital would have to inform you.

I believe you're referring to medical insurance. My problem with GE was for critical illness insurance.

Think mine's called Living Assurance policy.

The medical card does not have the above clause that exclude key hole surgeries.

However, For the critcal illness claim under the 36/42 critical illness for heart valve repair or replacement, yes, the keyhole surgery is excluded.

How detailed of a disclosure of the policy document depends on the agent/client during the delivery of the policy.

Some clients are okay to spend the time for a more detailed explanation, some don't.

some clients does not really understands or remembered or really pay attention to those medical terminologies used at the time of purchase.
I am one of those client......

The industry is flawed. Instead of helping customers in the time of need, they seem to be greedy and focused on profit, judging by the products and fine prints. Even using agents who have targets and earn solely based on commissions, do we realistically think every agent is going to be honest and ethical?

Referring to my initial post where I mentioned I regret buying the education savings plan for my son, the agent who sold me guaranteed the returns. The new agent told me he never promotes that product to his customers because the returns are very low.

is returns of the education saving plan really guaranteed as mentioned by the earlier agent? if yes, then he/she did not lie....

did that new agent recommend an almost similar education saving plan for your son?

Nope. I'm supposed to pay for 10 years (paid 9.5 years already) but only earn interest from 11th to 15th year. After paying more than MYR 100K, the cash value I can withdraw is less than what I've paid - I would've been better off even putting in FD.

He advised to buy unit trust.

Upon googling about Keyhole surgery, I wonder, why the insurers dont want to cover this? Because of underlying risk? Cost?

Upon googling about Keyhole surgery, I wonder, why the insurers dont want to cover this? Because of underlying risk? Cost?

Background:
I was a non-believer in insurance, mostly due to the aggressive way it's sold, up until I was 30 years old. Then a friend became a Prudential agent and I bought a medical card to support him, which also included life and critical illness protection, and very minimal investment.

Then I started freelancing and also bought a house and a car, so I thought of increasing my insurance - in case something happened to me, the insurance would pay off the loans. Still having doubts about the ethics of insurance companies, I decided to buy extra life and critical illness protection from Great Eastern this time to "diversify the risk".

Over the years, I increased my insurance protection and also bought insurance, including a 15-year education savings which I regret, for my 2 sons. I also started a company that grew to almost 100 people and have been buying company group insurance from Great Eastern - paying a premium of about MYR 70,000 a year.
Critical Illness:
Last year, I was diagnosed with a heart condition that was covered under the critical illness insurance. Due to my fitness level, I was able to undergo non-invasive keyhole surgery (more advanced, less painful, recover faster, smaller scar) to repair my heart, instead of the conventional open-heart surgery where they saw your chest bone and open up your chest.
Claims:
Upon discharge, I submitted all the neccessary reports and documents to both agents and on the SAME DAY. This was what happened:

Prudential
- the agent told me Prudential will respond within 14 working days.
- within that period, Prudential sent me an SMS saying the claim was successful.
- the money was paid into my bank account 2 days later.

Great Eastern
- the agent said don't know how long the process will take.
- a week later GE asked for "certified" docs, which were copied and submitted by their own agent.
- a week later, I was asked to complete a questionnnaire, including which other insurance company I bought from.
- then my claim got rejected.
- GE says based on the policy, I MUST undergo an open-chest surgery to qualify.

My agent was stunned and my cardiologist literally said "what the fuck?". My agent appealed and got rejected - twice. Finally, I wrote a long email to express my disappointment and detailed my entire journey with GE, comparing it with Prudential. My email was escalated two levels up ...and then NO REPLY for a whole month.

Then my surgeon wrote another report and appealed to them. Finally, my claim was approved but GE proudly emphasized that they were ONLY doing it out of goodwill.

I promptly terminated and switched my company group insurance to Prudential. I also did the same with my son's insurance.
Buyer Beware:
It's companies like GE the reason why I never trusted insurance companies. Even my insurance agent who had been selling GE for 13 years was unaware of such a clause, hidden in the fine print.

The insurance policies are supposed to cover us until 100 years old. So between now and then, if there's a new and more advanced medical treatment, we still can't use it because it's not covered under GE's archaic policy?

Over the 13 years, my insurance agent has sold over 500 policies. But including mine, he has only made 3 CLAIMS for critical illness/life to date!

Other issues that I had with GE, was with their online access which didn't work and customer support which takes a minimum of 3 business days to respond, e.g. "we will transfer your request to the relevant department". Seriously? In this day and age of Internet speed? In my last interaction with them, they took 1.5 MONTHS to reply "due to sudden surge of volumes of email" (I wonder why), by which time I'd totally given up.
Conclusion:
Be careful when buying insurance - it's easy to buy but difficult to claim. Based on my personal experience, I would highly recommend Prudential instead (for now). The PruWaiver that I bought meant my son's premium will now be borne by Prudential. My premium will also be borne by them and paid towards my cash value until my policy expires at 100 years old.

Hi just to share my story also about GE.

They seems trying very hard to reject claims by using many excuses/reasons. But i was able to fight for it and won it after a few phone calls with their "supervisor".

Just FYI if they trying to be funny, just tell them u will report to OFS (Ombudsman for Financial Services) and BNM (Bank Negara Malaysia).
Their services are FREE u do not need to pay anything, they will help u to deal with the insurance company.

His gripes are with the CI payout not the medical insurance.

If you read another post about that, keyhole was excluded circa 2006 from CI claims. Probably because if your illness can be cured via keyhole surgery then it's not "that" critical.

How many of us are actually given the opportunity to go through the entire document before we sign? It's the same in Malaysia for SPA, will, loan agreements, etc.