Again, in terms of hospital claims:

John goes to the hospital. Gets admitted.
Admissions will ask for his insurance info.
From here, the hospital will deal directly with the insurer.
From here, admission GL gets issued,
All the way to discharge GL.

I can't speak for other insurers, but for AIA customers, you can submit all your pre- & post- claims directly in the AIA+ app.
Does this resolve your ick with sharing your info with your agent?

No, agency force will never be able to access the underwriting and claims departments unless through email or paper forms.
Any form of comms other than black & white are not entertained.

No, insurers process claims on a first-come-first-serve basis.
And the standard TAT of 10 working days upon receiving complete documents has to be adhered to.

Of course, top agents have the head of claims or head of product.on speed dial.

The question is are you the top customer of the top agent ?

Yes of course, if you have multiple high sum assured policies and intro many friends and family, lagi preferential

Come on man, you are a long time agent. Surely you know the top agents have direct contact with claims, underwriting and product teams. Some even have enough pull to get the company to reconsider their decision

The standard policy wording on 24 months contestability period applies across the industry.
It grants the insurers the right to investigate. It doesn't mean that the insured cannot claim for high blood pressure.

So back to what I first mentioned, since there is no claim, the insurer cannot proceed with an investigation, because there is no grounds for them to do so.
Since the insured proceeded with seeking treatment at his own cost at UMMC and public clinics, the initial GL is left hanging.
With this, subsequent GLs will be flagged, pending the unresolved GL and questions left unanswered.

So the most natural thing for the agent to do is to attend to it, document the treatment records at UMMC and public clinics, and file for a manual claim so the insurer can proceed with the investigation procedures. It's very straight forward.

I know that it is easy to find someone or something to blame.
And then what does that achieve? Absolutely nothing.

The insured is already as confused as he is. The best thing to do is not to rally behind him to shout at curse and play the victim.
It is clearly an incomplete paperwork issue, then let's work on the paperwork lah. Bukan magic, tapi logic.

And what does his friend do? Wash his hands, pull himself away from the issues, push it to the claims department.
That's very very teruk lah.