Nobody's fault actually,

Insurance company has small prints on detailed T&C what can claim, what is not covered, trouble is most people buy without knowing small prints. But they are available if you ask for it.

Agents get commission from premium, often time only want to close a sale,telling customer no need to declare that small thing lah, lest application rejected. Some dont ask full medical history when filling up application, later customers will suffer when want to claim.

If T&C say payment is for above knee amputation, it has to be it to claim. Cancers also may not get to claim, those early ones, is in the T&C what can we do? Heart attack minor also cant claim, that is in the T&C again, must show this show and that fulfilled criteria only can get payment

Name that insurance company.

anyone following up on this 2nd policy claim of RM2mil ?...today is 14 April....

As an underwriter for 10 years now, let me come to GE's defense in their rationale for trying to void the policy.... I'm not working with GE, so this comment is not in support of them, it is just to let you all know how underwriters work....


The concept is easy, if GE knew that the client had history of anxiety attack, they would have declined the case right then.


So you have to do some imagination. Think of the sequence of events that would have happened if client did declare the condition during application.


In chronological order...
Feb 2014 - Aware of her psychological illness
Apr 2014 - had a psychological consultation history
--- 2015 - Bought 1st GE policy - without declaring that she did not have depression or anxiety at all material times
(**IF CLIENT HAD DECLARED THIS, GE WOULD HAVE DECLINED HER APPLICATION UPFRONT, HER APPLICATION WOULD HAVE NOT EXISTED.)

Feb 2017 - diagnosed with anxiety attack and was prescribed Xanax
Feb 2017 - consulted with another doctor + infection in body
--- 2018 - Bought 2nd GE policy - without declaring that she did not have depression or anxiety at all material times
(**IF CLIENT HAD DECLARED THIS, GE WOULD HAVE DECLINED HER SECOND APPLICATION AS WELL, HER APPLICATION WOULD HAVE NOT EXISTED.)


Fast forward to now, client had cancer. Can she claim for her policy if these 2 cases was already DECLINED in 2017 and 2018? Can she claim if the policies does not even exist, because like Thanos, it has been snapped out of existence??
**You can use Back to the Future as an example. If you go back in time and "kill" someone (i.e: Decline the policy in 2017 and 2018), will the person's child (i.e: the claim) still exist now?


Imagine, person A rob a bank and buy a house. When person A got caught and the police realize, the $ no longer with person A but is now changed to a house. Should person A get to keep this house?

---> Apparently, Malaysian courts say "YES", coz it is no longer the $$$ that was robbed from that bank. Logically, the house should not belong to person A, coz it was WRONGFULLY acquired from illegal means.
In another context, Rosmah is innocent, coz the money from 1MDB is no longer available, it is now in the form of Berkin bags. The Berkin bags were bought legally, so it is OK. Innocent Rosmah.

---> So same as this case, the person lied and illegally got the policies. Should they get to keep the $$, even though it should not have belonged to the client in the first place? Imagine if you got conned by a conman and the conman buys gold using your money. The police catch the conman and can only find that gold. Will you want to get that gold back? Or will you say, "Oh, my money is no longer here. That gold belongs to the conman coz he buy using "his" money"?



GE is not disputing that she cannot claim due to cancer. They are disputing that this 2 policy is ILLEGAL, coz she lied to get them.

What the court had done, is just to encourage everyone to LIE. Don't care about the consequences, just lie upfront.

So Malaysians should not complain if in future the insurers all start to raise premiums. Actuaries will start to take into consideration that a higher amount of people will lie and the health declaration in the application form is not reliable. So the only way is to charge everyone higher, including most HEALTHY AND HONEST ppl, who I believe are most Malaysians, so that they can be prepared to pay claims of policies that are obtained by LIARS.


This will lead to a spiral...
- More ppl lie during application coz the courts say it is OK to lie,

- Higher claims, coz ppl are just lying to get policies, they can be super unhealthy and still get policies.

- Insurers, to ensure they don't lose money due to the claims, have to increase premium prices,

- Higher prices, discourage healthy and honest ppl to buy insurance, coz why buy when it is so expensive? Their chances of claiming is lower anyway. (As in, they are healthy are have less chance of getting ill, such as heart attack, as compared to say, an obese BMI 40, who smokes 1 pack a day)

- Unhealthy ppl will prefer to buy insurance and lie to get their policy, coz pay a little bit can get more $$ from claims, why not just lie?

- This cause claims to get even worse, as less healthy ppl buy but more unhealthy ppl buy

- Cycle continues, premiums keep getting more expensive year after year....



If you have the chance to go to Singapore, try getting a quote for the same cover as Malaysia. You will quickly realize, Singapore life insurance is cheaper than Malaysia. This is due to their Actuarial calculations, that allow for lower rates due to their higher health quality and the better insurance laws.

This post has been edited by Limster88: Apr 16 2021, 12:24 AM

Thanks for clarifying, knowing this is the internet, there are bound to be individuals who tend to comment on the insurance company without being on the insurance company shoes and assume that the insurance company is not paying because they're a scam. (Some on the sarcastic extent of telling others to cancel all their insurance policies).

Again, I won't be surprised that the attack will further continues after your post because they choose to defy logic & reasoning and assume that they as a consumer is always right and have the right to bulldoze their way through to get what they want.

However that being said, I'm interested to know what are you working on now ?

I'm still a Life underwriter, though i am now based in Singapore and work for a Singaporean insurer.
I started my career in Malaysia, so i know how Malaysian life insurance companies work. It is the same concept everywhere actually, modern insurance policies dont really differ too much nowadays.

Oh great to hear that

How is the insurance industry going for Singapore if I may ask?

But I would like to know why most, if not ALL Malaysian insurers will reject those with short term psychological history? No exceptions? I suspect I might have depression but I refuse to go and see a psychologist because I know having consulted any mental health professionals will get my medical card upgrade declined (which validates your point of some people will not reveal medical conditions to get covered for life insurance or medical plans).

However with the fact that at least 30% of the Malaysian population have some mental health issues, the increasing awareness of it and also as we become more developed - more and more people will become stressed (Japan, Korea, China and many advanced countries have high suicide rates), I am surprised insurers don't offer cover, at least to those who might have short term mental health issues (like needing some psychologist consultation to cope with grieving the loss of a loved one).

scam then scam la. No need to spin around. everyone knows an insurance company is there to make money. They are a business entity. The same goes for the agent. Before buy can say anything no problem show proof here and there, people claim x amount etc. But when come to ownself want to claim..all sorts of excuse and story come out.

You are saying that the insurance company doesn't go do a background check before giving approval? I am sure they have the resource to do so. Clearly want to get free money la coz probably already know this person can't claim yet approve the application. At least reject their application to prevent them from paying the premium. Not until people pay for years than when want to claim the insurance company only go dig out all history to block the claim (which they should do upfront). It's con job practice la. Everyone knows that.

I am not sure how well versed you are with Insurance contracts but they run based on the Principle of Utmost Good Faith.



What is the principle of utmost good faith?
1. The principle of utmost good faith, uberrimae fidei, states that the insurer and the insured must disclose all material facts before the policy inception.

2. Facts which may enhance the level of risk are called material facts.

3. The insurer or insurance company needs to declare all public disclosures and investment strategies while the insured needs to declare health condition, family medical history, lifestyle, food habits, smoking and alcohol history etc.

4. In case of non-disclosure or misrepresentation of material facts, the policy can be considered null and void.

5. This principle applies to both life insurance and general insurance policies.

How sure are u GE would not accept the policy but rather to underwrite and exclude any illnesses related to the condition?

What does anxiety attack means? and does it really that big an issue would get application declined?
Could have just underwrite exclusions say maybe suicide not payable?

Now if one are saying "past and future" grandma stories, what i mentioned could have happened and her policy would have been accepted hence her claims for cancer will be payable no?




Btw lifebalance the court case 14 Apr what was the verdict?

again, Google Principle of Utmost Good Faith or refer to my post above.

Sorry, didn't follow up, probably let me know if you got the news

Actually, what or how should she disclose about that anxiety attack issues?
I mean from the proposer form i cant think of which section/question that is related to anxiety attack and/or physiological issues.

I guess if i was her, i would not have think about disclosing it too because it was not related to anything.
i mean its just like going to clinic for a common cold medications.

In chronological order...
Feb 2014 - Aware of her psychological illness
Apr 2014 - had a psychological consultation history
--- 2015 - Bought 1st GE policy - without declaring that she did not have depression or anxiety at all material times
Feb 2017 - diagnosed with anxiety attack and was prescribed Xanax
Feb 2017 - consulted with another doctor + infection in body
--- 2018 - Bought 2nd GE policy - without declaring that she did not have depression or anxiety at all material times

She should have declared that she went to seek psychological consultation / anxiety attack.

My guess since the psychological consultation may not have resulted an anxiety attack, GE probably let it slide and hence the case was won by the claimant and GE agrees to pay in the end, but the 2nd policy may probably not pass the payout since the diagnosis was on Feb 2017 and was clearly diagnosed with medication but there was no declaration on that made for the 2nd policy.

This post has been edited by lifebalance: Apr 16 2021, 01:33 AM

So clearly shows GE trying to cheapskate payment no?
The question u did not answered, what was the issue with psychological illness that may affect a life policy?

It could affect a medical card but even that is insignificant as this illness is not claimable correct me if im wrong.

Like i said, i wouls have just treat it as going to clinic for a common cold problem and would not have thought of need to disclose it.

It's been explained by limster88. I've assumed you have read his post since you quoted him earlier.

just curious.. AIA now offers insurance benefits for mental health, so if declare got mental health issue still can buy ?

Subject to the Underwriter's discretion to accept your application

The problem with the Malaysian style of attaching health riders to an ILP plan is that when an underwriter needs reject the life plan, everything attached to it will be rejected as well.

Mental conditions have a great impact on life cover. Suicide after the waiting period is claimable, so for a person with history of mental issues it is one of the risks the insurer had to take into consideration. Depending on the risk philosophy of the company, some companies will decide that these risks are not something that they want to take.

In the end it is all about price. A more conservative insurer that screens out applications more tightly can limit its future claims. This gives it more room to either earn more profits, or, reduce / control premium prices to be more competitive in the market.



And yes, insurers adopt the utmost good faith concept in approving policies. This is also in line with PDPA regulations. After all, if you are honest upfront, there's nothing to worry about right? An insurance policy is just a contract, so the insurer is bound by it if the premise of the contract is valid.

The government also do not want the insurers to willy nilly obtain and keep people's personal health information, so this is the current practice. Not all policies will turn into claims, so there is no need for insurers to be so intrusive and check everyone's health background. You think that the insurers don't want to get everyone's information? Given the chance they definitely want to. More information means more accurate actuarial projection, means better pricing and competitiveness.


Long ago, before PDPA laws came into force, we used to have this LIAM system, where insurers will share with each other on the health conditions of their clients. There is no escape. If you are rejected by company A, then you try to apply with company B, you will also be rejected coz they also know about the health conditions too.

Then came PDPA enforcement and all these ended. Now the industry had to operate on a more limited information and therefore had to start trusting their customers based on utmost good faith.

The only time the insurer has expressed approval to check everything regarding to your medical background is during claims, because this is the only time that PDPA rules allow them to fully access your medical records. So you can be sure that if you do not disclose information to your insurer and they find out about it, it will then go to post claims underwriting, where we will re-underwrite the application again, assuming that if we know about the condition in the first place, what will the underwriting decision be.


For example, let's say someone lied about smoking during the application, thinking that they can pay cheaper premiums. This commonly happens.

The problem will come when they claim, coz when their doctors ask them about their health condition, people tend to answer honestly so that the doctor will be more accurate in their diagnosis. So upon claims and the insurer gets the medical report from the doctor, claim assessors will cross check the declaration and information from the doctor and if they find out that this client had been smoking when the application was signed, you can bet that before paying out the claim, the insurer will readjust the contract and calculate all the back pay of premiums that this client needs to pay, which they can either deduct from the claims payout or if it is not enough, demand the client to pay the balance. If the client refuse, then obviously this contract is not valid from the start, and the insurer can void it.