Just for clarification, is the counter offer a loading (on condition 1) + exclusion (on condition 2)?

Yes, of course.

Mind sharing the experience where any insurer "just pick a word from the policy to reject a claim" ?

Maybe you can let us know about the product name? There are many archived brochures that we can find online.
Secondly, you may also refer to your policy contract, because that is a legally binding document.
There are many different kinds of CI coverage, which provides coverage at different levels. Perhaps you can refer to the company CS rep over the phone for clarity.
I know it sounds like I'm handing out assignments, but I'm just trying to live up to your level to be specific here.

Just like you said, we are agents, aka intermediaries. We are not the claims officer nor are we fit to assess medical reports.
What we can do during a claim is to assist with the claims process.
However, regarding the CI products that we sell, they have different levels of coverage and come with different costs.
I think it does require some level of proficiency from us in order to sell these products.
It may not be specific to the conditions, but those are explicitly mentioned and printed too.
In fact, should your condition qualify on other terms such as "unable to perform self-caring activities", some CI policies have such terms, there is no reason for the insurer to deny your claim.

Perhaps I can encourage you to hangout with more insurance agents, and talk to them about insurance products in the market.
Nobody is trying to sell you something all the time.

The short answer is Yes.

The long answer is this:
Under Early Critical Illness coverage products (pretty generic), yes it covers. Once diagnosed, there will be a payout (usually at a certain predetermined percentage).

Under accelerated Critical illness coverage products, it requires not only SLE, but also with severe kidney complications before it qualifies for a payout.

During proposal stage... when such a specific question comes up, it's so easy, just dive into the policy wording and it will be printed there.
After that is done, the next question to ask is "does it run in your family? Or have you been diagnosed before? How come so interested in SLE?"
Fact-finding mah, sure will ask if the prospect is being oddly specific.

Note that I'm trying to be as generic as I can, the statement above should only be taken as a reference, kindly refer to your own policy contract for more certain terms of your own coverage.

Also note that I do not know mini orchard's condition, I have not seen his/her report, I have not seen his/her policy contract, I am not his/her writing or servicing agent, nor have I ever assisted him/her with any claims, I never met him/her in my life.

The person to determine your condition: your attending physician
The person to assess your claim: claims officer

I'm merely providing generic information.

This post has been edited by JIUHWEI: Aug 30 2021, 01:39 PM

Very frankly, let's say someone asks me "hey, do you know if SLE is covered under CI?"
My answer will likely be "I don't know, let's find out yeah?"
Proceed to pull up policy wording.

Hmm...nobody walks around with brochures anymore.
In fact, there are policy wordings that can be accessed in order to find out too.
With all the tech today, it's a matter of minutes to pull such documents up.

Yes, a new buyer will likely take the short answer.
But when looking at the policy wording together, it's quite difficult to avoid the lingering sentences / other columns in the table or schedule.

Unless there is an effort made to hide some info.... which I can't imagine what benefit would derive from that..

While the sound bytes presents itself as an idea worth considering, I'd like to provide a few other points for consideration:

1. A Term Life, while it is cheap, also comes with an expiry, which is the term that it covers for. In this case, a 30-year term.
Come the end of the term in 30 years, a lot would have happened. What's most likely to happen is that your assets would have at least doubled, and you are worth much more than you are now. At that point in time, should you want to continue having your Life Insurance, you would have to apply new, knowing that your current 30-year term is expiring.

2. Should you decide to continue having the coverage, your only option is to apply new, subjecting yourself to underwriting at that age.
In 30 years, it is guaranteed that our health won't be the same.

3. What do you think the net cost to you will be in 30 years? And then to top it off, considering to buy another 10-20 years of Life Insurance at that time?
It's rather off-putting, imho.

4. Should there be a reducing sum-at-risk proposal, would you consider that? Simply put, the only COI charged to you is to insure the balance sum-insured minus the policy fund value. So as your policy fund value grows, the sum-at-risk reduces. The premiums are leveled to age 100, guaranteed.
Your sum insured can start at a minimum of a million ringgit (or dollar).

I trust that these are points worth considering.
What do you think?

This post has been edited by JIUHWEI: Sep 10 2021, 01:55 PM

If a person decides to migrate from Malaysia, they don't have to surrender the insurance policies bought here.
For Life, Critical Illnesses, and PA, the coverages do not have a territorial limit.
Take for example, should a claim arises, one simply needs to provide the same documents to file for a claim.
Whatever bank the beneficiary holds, the payout will be transferred there.

As for your critical insurance coverage, they each have their unique features and benefits.
You do not have to buy all of them (there is no such thing as a "best ratio". However there is such a thing as an immediate amount needed in the event of a CI).

I do have customers who have migrated to UK, Australia, Dubai, and UAE.
All of them maintained their policies here, while at the same time buying a medical policy where they are.
Of course, they have all been there for less than 10 years. Should they decide to have more permanent plans, we will review their policies again as and when their plans come up.

Some may think that maintaining one medical policy in Malaysia while they are overseas is a waste, it was they who educated me that geographical changes do have a correlation with increased health risks. For the purpose of keeping their options open, it is best to keep a medical policy here in force.

Every insurer has the same claims procedures, requirements, etc.

Involvement in any criminal and illegal activities (such as bersih rally) are generally not covered by any insurance companies.

Like buying any businesses, one buys over all its assets, debts, and obligations.

A most recent example would be as posted above, AIA buying ING in Malaysia.
So all the policies issued by ING Malaysia in the past are now under the management of AIA Malaysia.

The same (being bought by another insurer) happened to Malayan British Assurance (MBA), Aetna, etc.

Yes you can. However, it is based on the principle of indemnity. One cannot "profit" from a medical claim.

It is very common for people to have 2 medical cards.
One provided by the employer, and one that we purchase on our own.

It is usually the case where we will exhaust the coverage provided by our employers first before we start using our own.

This is how it works:

1. John Doe files for a medical claim with his employer-provided medical insurance coverage.
2. From there, he is entitled to RM 50,000 of coverage. However, his total bill comes up to RM 60,000.
3. The employer-provided medical insurance will cover for RM 50,000, and John is billed RM 10,000.
4. The hospital then will issue a receipt to John upon payment of the balance of RM 10,000.
5. With that receipt (and other relevant documents), John files for a claim with his own personal insurance policy.
6. His own insurance policy will then cover for the remaining RM 10,000 (less any deductibles and/or co-insurance if applicable).

Do let me know if I addressed your query accurately.

They can always reach out to any of the company service branches.

Apart from that, nowadays there are customer portals that can be useful as well.

For example, I got into a road accident this time last year.
Car accident, broke my hand, very bad.

Items to be claimed:
1. Third party claim against that driver (happen to be insured by AIA as well)
2. Loss of use
3. Medical bills (also against that driver)

All of this was done online via email and the AIA claims dept was quite helpful as well.
It was quite a smooth claims experience and gave me much more confidence after experiencing the claims process myself.

Yes, you can.

As long as it is within the bounds of the principle of Indemnity, it is permissible.

Has it ever crossed your mind that career insurance agents like myself and many old-timers here, stay in this career because we have a vast network of very successful people and their friends behind us, supporting us?

And when you need some help or a recommendation, you usually get it from your insurance agent because it is most likely that they know the best people.

What can an online insurance portal tell you?
"Sorry sir, you got the wrong number. We're an insurance company. We can't help you with that."

I personally helped with company internal branding to employees, arranged durian parties, charity drives, etc.
Of course I don't organize these things, I simply link people up from among my circles and network.

I feel my real worth, other than insurance advice and services, is the network that I have built.
After all, people that continuously buy insurance products usually have a strong sense of responsibility towards themselves, their family, and the organizations and communities that they are involved in.

Claims dept would need a kick-ass story for why it took 2 years to come forward on the claim.

Otherwise... they actually can throw it out on the grounds of "untimely submission".

Yes, this provision is expressly stated in every policy wording. Across the board. Even motor insurance.

As long as there is no medical record of a diagnosis or a health report of any kind that was omitted upon application.

It is okay that a person did not know upon application.

I believe the first step for you is to call up the bank, and find out exactly what the coverages are.

From there, you can then ask yourself the questions:
1. am i adequately covered?
2. do these plans fit my objectives?
3. what do I want or what are my objectives?

Then when you finally decide to speak to a life planner, you have a rough guide in your mind on your expectations.
We can work within your parameters.

These homework are necessary for anyone to do.
Otherwise, the meeting with any life planner will be a waste of your time without a clue of where you are, what you want, what you currently have, and where you want to be.

You can expect life planners like myself and many others here to fact find and grill you in order to do all the above for you.
A pre-requisite for that to happen is for you to divulge all your details, all your finances to me without holding anything back.
Just like all the other professions, we need to work with data in order to give you reasonable recommendations relevant to you.

__________________________________________________________________________

If I can be frank, have you ever jumped into a cab and see if the driver knows where you want to go?
That sounds pretty bizarre, right?

Or going into a bakery and ask for the "best" cake.
How would the shopkeeper know if you have any allergies or preferences? The best they can do is to point out their best-seller, which is none of your business, but then if it hits, it hits!

So when you asked if those plans are necessary...
We don't know heads or tails about you...
How to advice?
Better say "yes" loh...
Otherwise any bitter gourd tofu, we cannot afford to be the one liable, telling you "not necessary" and there goes our name and career down the drain, let alone living with the guilt.


Sorry lah, a bit long winded.
But it is my betul feeling, and I felt it had to be said.

I'd like to shed some light on this issue on medical report fees.
I assume that there is a cashless facility on your medical insurance, correct?
What was the reason it was not utilized?

The medical report fees on claims is charged to the patient. Even the receipt is issued in the name of the patient.
If the cashless facility is utilized, the medical report fee will be charged directly to the insuring company, and the report is then released to the insuring company for the purpose of documentation and subsequently paying the bill.

Secondly, I also wish to ask why is there no servicing agent?
Did you purchase the policy from a bank or online?
I ask because I refuse to believe any agent today will risk a complaint as it will affect their BSC.

Should you have bought the policy from a bank, then the one failing to provide the service is the bank. Banks act as corporate agencies selling bancassurance products, they then owe the service to you.
Should you have bought the policy direct from the insurance company, there are no commissions paid to anybody. Hence, you gta do these runs on your own because nobody owes the service to you. The insuring company is only liable to the amount being claimed.
Should you have bought the policy from an intermediary like myself, then he/she owes the service to you.

I see. Thanks for clarifying.
Wouldn't it be a better alternative to engage an insurance agent or life planner for your insurance needs?

In the case of applying for a critical illness claim, yes there are certain documents required. No worries, it is not complicated.

For a critical illness claim, usually a medical report is required from the attending physician to confirm on the diagnosis, condition, and date.
The purpose of carrying out an investigation is just to ensure there is no case of non-disclosure during policy application. However, it is quite weird that you have to sought for the GP records on your own. Reason why I say this is because signing on the Life and CI policy application, you also authorize the insurer and relevant government institutions to obtain your medical records from licensed medical facilities and institutions. With this claim and subsequent investigation carried out, it is a matter of written letter communications between these entities. Perhaps there is a recent update to FSA 2013 that I am unaware.
Of course, a Critical Illness claim for needs to be filled as well. The relevant forms can only be obtained from PBB.

ON TOP of that, yes the insurer also reserves the right to investigate under the contestability period provision. Filing a claim against the insurer at this stage would be futile, but perhaps you may have a case against PBB for failing to comply with the provisions of FSA 2013 under ethical and professional conduct. But that is up for debate. The OFS would likely advice as such too.

Just an observation and I'd like to ask all forumers here,

Anybody ever got a document that states something along those lines?

Or

Has it always been delivered verbally by the bank officer?

Ya, cuz right now most of the servicing are done by agents.

Should agency be abolished, that would be an unfortunate possibility.