GE = Generally Excluded

if you mean this benefits,...
COVID-19 Private Hospitalisation Assistance Programme
Coverage Period
Hospital admission date from 27 March 2021 to 30 September 2021, both dates inclusive, or upon reaching maximum claims limit of RM1 million, whichever is earlier

https://www.greateasternlife.com/my/en/pers...stions.html#cph

COVID-19 Vaccine Fund (Existing Great Eastern Customer)
When is the coverage period?
The coverage period started from 25 February 2021 to 31 December 2021 or until the COVID-19 Vaccine Fund has reached a total claims payout of RM1 million, whichever is earlier.
https://www.greateasternlife.com/my/en/pers...stions.html#cvf

So, let’s say the incontestability period of, say, 3 years is over and a person with a history of hypertension (who did not state that he had hypertension on application because he genuinely overlooked or could not remember) now comes forward to claim for heart surgery (5 years of paying premium )...can insurance company reject the claim ? Or they must pay based on incontestability period being over?

If hypertension, then he should have been on medication, then he "should" not forget, unless he wanted to "cheat", then it is fraud....
Well that is my thinking only, up to the odusman claim tribunal to decide.

Unless maybe for things like asthma attack 30 yrs ago when in kindergarten,... Then no more happens for 30 yrs,.. Then buy insurance at age 35,...where can remember abt that asthma so long ago.... But can insurance reject for non disclosure for things happened 30 yrs ago? This also my thinking only ya

This post has been edited by MUM: Jul 14 2021, 06:07 PM

Actually what I am trying to ask is: if we have been paying premiums for 5, 6 or even more than 10 years, can the insurance company still deny claim saying we did not fully disclose? How do they differentiate between fraud and genuine overlook or omission? Do they routinely still check for all these misstatements after 10 years of paying premium?

i think the insurance SIFUS would have experience or knowledge on that topic more....

my guess and just wild guess just for discussion only,...
depends on the case, if bad luck, the patient had a history of chest pain 12 yrs ago and was admitted into the current same hospital for heart attack,...then the hospital can easily provide that data to the insurance company.....then i think KENA lah ...

read before, insurance company can when needed, will also ask clinics near your residence/workplace address ( heard was 2~3km radius) to check for records too

if genuine overlook, and the non reported issue was "not" related to the cause of the illness of current claim, then i think should be claimable.....
see attached image of a latest "happy ending" as posted by a forummer of his experience....

Ask Medical and Life Insurance Claims, Payment of Claims (Insurance)
https://forum.lowyat.net/topic/5019223/+40#entry101573117




Attached thumbnail(s)

hi cmk96, basically, no medical card cover covid-19 expenses except for certain medical cards from AIA. if you come across any, do correct me. those that covers are those from the special relief fund which acts like an allowance/reimbursement to a certain amount.

hi aspartame, if this insured got history of hypertension and say he knew about it (meaning got medical record in any clinic/hospital/lab), if such claims happen, company still got the right to reject the claim and void the policy because this falls under the non-disclosure clause. for the genuinely overlooked/could not remember, can try to write in and try to appeal. of course final decision of appeal is not guarantee ya but if there's a chance, why not.

also i think during the insurance application process, agent plays important role in asking all the disclosure health questionnaire. by asking in specific, likely can remind the insured of past history unless really something that the insured isnt aware of.

if there is really something not disclosed, then yes company can deny they claim. how company differentiate is... if they cannot find evidence/proof of medical history, they will treat it as a genuine case. if they dig and find out certain medical history that isn't mentioned in the insurance application, then they will treat it as non-disclosure case and further investigate to find out more.

So basically non-disclosure clause will still rule in spite of the incontestability clause of 3 years? Thx

yes you are right. in fact if you see those cases with all these disputes, most of the policies are already more than 2-3 years still stuff like that happened.

Ok thx. I think a good agent is important. I can imagine some ruthless agents running through the questions quickly and casually with the clients in a rush to close sales when the disclosures are actually the most important as any omission can potentially come back and haunt us. Yet, I feel insurance companies somehow intentionally or otherwise never put an effort to stress this point .

companies actually passed this responsibilities to the companies' trainers and to the agency managers/leaders. i remembered when i first joined the industry, the agency leaders didnt stress much on this, in fact didnt use proper form to fill the application. well, i have to find out myself what is going on as i progress through. that's the reason why i quit the first agency i joined and found another agency which is more professional and really stress on this a lot. that's how agency that really do this business properly can grow big and we really won't tolerate agents that simply go through the application form.

-

This post has been edited by Michael_Light: Jul 17 2021, 07:28 AM

Just wow , 4 month claim still cannot approve

This post has been edited by MrBaba: Aug 24 2023, 08:51 PM


Attached thumbnail(s)

In instances where the enquiries/ feedback/ complaints remain unresolved, you may refer your enquiries/ feedback/ complaints to the Ombudsman for Financial Services (OFS).
Or / and
PIAM Information Centre (PIC) assists to resolve any consumer enquiries/ feedback/ complaints on insurance matters and other matters under PIAM’s purview

Insurance Complaints & Mediation
https://piam.org.my/complaints-mediation/

This post has been edited by MUM: Aug 24 2023, 11:27 PM

That's why I always have issues with insurance

So far only GE very sial saja rest all okay

Tq for the info

Wow this thread resurfaced.

Any latest info about the case? Tldr

Wooi. Who Necro this.

Another Insurance to beware of is Prudential.

what happened this time?