Home / Malaysia Insurance Law / Insurance Law Declined MRTA Insurance Claim 180 days disclosure clause in relation to MRTA policy

Declined MRTA Insurance Claim (modified 0 times) Alex Dear All, Would greatly appreciate your comments. My elder sister recently passed away due to cancer and we put forward a claim to the insurer, disclosing all the relevant information. However, the claim was declined as the insurer insisted that my sister did not disclosed her illness as per the clause “this offer is valid for 180 days subject to no change in health status from the date of application” (stated in the Letter of Approval). My sister applied to purchase the MRTA in April 2003 and was only diagnosed with cancer in Sept 2003 (5 months later). I know it's not more than 180 days later but my questions are as follows: 1) Is it reasonable for Insurers to impose such clauses? (When one is diagnosed with a fatal illness, the main thing on their mind is finding a cure, not to inform the insurer about some policy which they purchased 5 months ago. Who would remember such things?) 2) Wouldn't this be superseeded with the clause in the Insurance Policy stating that “this plan does not cover pre-existing condition for 12 months from the effective date of coverage”? My sister passed away about 18 months after insurance policy was in force (i.e. in Year 2 of the MRTA policy). 3) What recourse (e.g. legal action) do I have against the insurer, if any? All comments are welcomed. Thank you very much. Warm regards, Alex Ng 04 Oct, 2005 18:21:16

RE:Declined MRTA Insurance Claim (modified 0 times) LoyerBrook You should consult a good lawyer. Insurance policies are always written unilateral, meaning favouring the insurance company, thus, most lawyers are not interested to fight insurance cases. If your lawyer can prove that there is no misrepresentation of material facts during/in the course of signing the proposal form then, you might have a case. 06 Oct, 2005 00:26:48

RE:Declined MRTA Insurance Claim (modified 0 times) Amarmekber Alex, The insurance company is well within its rights in refusing the claim arising from your sisters death. The first clause you mentioned, the 180 day 'no change of health' circumstances clause covers their risk. A risk did arise which in their assessment was an uninsurable or unacceptable risk. What would have been appropriate under the circumstances involving your sisters case would have been for her and any of you to have complied with the condition by informing the insurer and then seeking to negotiate a newer and perhaps higher premium policy considering her diagnosis. Not all cancers result in death. It would have put the parties in an equal bargaining position because whilst your sisters risk would be her health and surviving her condition, the insurer's risk would have been whether to risk covering her and for how long and how much. It is sad especially for those of you left behind to mourn her loss. However, to go after the company now as someone suggests on the knowledge of an apparent breach on your sisters part in failing to inform the company whereby they are prima facie covered, would be to throw good money after bad. Insurance companies work on the basis of risk and insurable risk, probabilities and yes profits and losses. Those who do not understand it make fictitious claims of bias and unilaterality etc and thats not correct although it may appear so. I am sorry for your plight and, No don't go after the insurer for misrepresentation. It is unlikely to succeed. If an insurance agent made misrepresentations you will only have a claim against him or her and not the company. The second clause you mentioned is mutually exclusive in the context of the first clause if read with the policy which I think is universally standard although I have not read your particular one. I hope this helps. 06 Oct, 2005 12:31:17

RE:Declined MRTA Insurance Claim (modified 0 times) Jordan Low Dear Alex, I'm financial planner. Regarding the case you face, i can explain to u is the MRTA didnt cover critical illness, is only cover death and total disability only, if for additional coverage u must add the premium. *Subject to policy term and condition* Jordan wealthplan2u@yahoo.com 23 Nov, 2008 16:09:55

RE:Declined MRTA Insurance Claim (modified 0 times) Dime i dont trust insurance company...!!! 16 Aug, 2010 14:19:09

RE:Declined MRTA Insurance Claim (modified 0 times) ayan when it comes to financial matters, always read the fine print. your sister would have avoided problems if she had informed the insurance company as is required by law. You can't say that you didn't know it when it's written in the policy. __________ motorhome insurance online quote 25 Nov, 2010 01:03:31

RE:Declined MRTA Insurance Claim (modified 0 times) Mike Dear Alex, Yes, you can submit your claim.... read the policy and the proposal form. If time doesnt lapped... quickly do it. I recently submitted 1 repuidated case for a client and won, ,my fees is 50% of the benefit.... no win no pay basis ... Hope this help. 19 Jan, 2011 16:42:19

RE:Declined MRTA Insurance Claim (modified 0 times) Fauttsd Hi I am having MRTA problem as well with one of the insurance company. It is not on the claiming issue. Recently I bought a house with MRTA insurance. It is only a low medium cost unit with 99 years of lease hold. When I first applied for the bank loan inclusive of this insurance, I was told to do a medical check-up - which I did. I have not being diagnosed with chronic illness - cancer, heart failure, high blood pressure etc etc. So my housing loan is approved a month after I've done my medical check up. Beginning of this year, I have started make my installment to the bank. Just recently the insurance company said that I have to make additional payment to my premium because of my weight and my height. I felt insulted and discriminated at the same time. Can someone advise what should I do? 31 May, 2011 15:19:30

RE:Declined MRTA Insurance Claim (modified 1 times) Rakyat Profile Hi Mike... Do pass us you contact number... Appreciate it... 23 Jul, 2011 00:15:04

RE:Declined MRTA Insurance Claim (modified 0 times) wann2011 Hi everyone. Maybe something we can discuss & disclose here, as far as am i concern, the MRTA Insurance does not cover for Critical Illness (deceased). Or maybe now Bank Negara has changed the rule? someone expert or have info please update here for our own good for the future. thank you 03 Sep, 2011 10:09:21

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