briefly browsed through the long long article... while waiting for gurus or experts to comment....

It is articles or news such as this that we should hold on to our old medical card for a while even when someone already gotten a new policy elsewhere.

also never buy into the nonsense by agents who said please buy as expensive a policy that you can afford for your future.

Annually FMOS did publish some of their "done" dispute settlements cases for that past year.
If have disputes regarding claims issues, can try lodge it with FMOS

Attached are just some case studies and settlement decisions published in their 2024 report




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I feel for the people who have to endure endless claims denials and follow up queries, but from my experience, >90% of the time the insurance company is in the right and act in accordance to their T&Cs.

People need to understand that the way the law and medical insurance framework stands, insurers will only thoroughly investigate at the point of claim, NOT underwriting. Is this fair? I think not, but that's the system. Too much resources would be wasted to thoroughly underwrite.

Besides, witholding information and being dishonest in your application will always come back to bite you, despite what your agent advises. The reason for this is because in Malaysia, individual medical insurance contain a clause: pre-existing conditions are NOT covered.

Some things like high blood pressure, high cholesterol and diabetes, can inevitably be linked to almost every single ailment. Besides, even if something completely unrelated were to develop, an insurer can invalidate your entire policy for failure to disclose your past medical conditions (including mental health issues). This is because it is not the insurer that bears the claims cost, but rather other insured in the insurance pool (which is you and me).

In this case, I won't be surprised that Allianz has sufficient ground to reject the claims and probe further, the timing from the insured seems fishy.

Sadly, we will be seeing more and more such news hitting social media, unless there is a reform to the medical insurance system to cover pre-existing conditions, a la the USA. But that won't be easy, given the propensity for adverse selection in such a situation.

The crux of the matter stems from the first GL rejection for the hypertension visit.

Insurance companies are all about compliance. And by compliance, I mean paperwork, paper trail.

What the agent needed to do is to write in on the timelines of the insured visiting UMMC and a public clinic for treatment, and subsequently attach together the relevant reports/medical records to be submitted for further review. This is building the case.
But I guess it was left hanging and nobody bothered to attend to it.

If he were to have went ahead with the initial treatment and sought for a claim, then Allianz will be able to start an investigation because then there is a case for it.
But since it was left hanging, there's no grounds for Allianz to even start an investigation since there is no claim.
So now the question mark will forever be there in the insured's file.

It's just a matter of communicating with the claims department and work on the documentation.

The agent sumore push away to the general claims department email.... Aduhhhhhh

To be fair, I don't think Allianz has outright rejected the claims.
The whole thing sangkut because the first admission GL request was left unresolved.
When there is no claim, Allianz didn't even have the chance to investigate.
Then with the follow-ups that were also unable to proceed due to the unresolved initial GL, created a whole series of unnecessary confusion.
The agent, aka INTERMEDIARY, wasn't mediating anything.
Beginilah jadinya.

Will the insurer bother to run around on behalf of the insured?
No, because it is the insured's duty to file for a claim.
And the intermediary collected the commissions, might as well render the services.

No doubt there are these bad apples among agents. I frankly really understand the stigma that some forumers here hold against insurance agents.
In this specific case, I think Allianz Life is very innocent lah.

haha... Allianz Life is innocent.... ..... delay long enough, policy holder gone... no need to bother anymore.

stage 4 tongue cancer... plenty of time to delay it seems.

This post has been edited by Wedchar2912: Yesterday, 06:46 PM

17 months from insurance date he got high blood pressure. That is why need to wait 24 months before claiming for high blood pressure. That is main problem causing his insurance to decline.

This post has been edited by Ramjade: Yesterday, 10:07 PM