1. I have submitted my claims, but until now I have not received my money? Why?

Transcription

1 Frequently Asked Questions (FAQ S) For a list Other FAQ s, click here Claims No. List of FAQ s on Claims 1. I have submitted my claims, but until now I have not received my money? Why? Everyday, insurers receive various types of claims whereby each claims requires different number of days to be resolved. It is due to the complexity of the claims cases or the claims submitted do not meet the criteria required. For instance, death claims, critical illnesses claims or total permanent disability claims. There are claims that require some time to be resolved compared to minor claims. This is due to the time taken to verify all documents provided by policyholder. In fact, the verification is done together with third parties such as the hospitals and authorities. The claims can be resolved amicably; provided with sufficient relevant documents. But when documents are incomplete, it will take more time to process. Generally, claims submission that comes with complete documents with accurate health details in the attached documents, won t take more time than it should to be resolved.

2 2. Why does my insurance company refuse/reject my claim? Your life policy is no longer in force, lapsed or expired due to cash value exhaustion. It could be because of non-disclosure material, claims for event falls under excluded risk and not within the scope of coverage. It could also be because the disability or illness does not meet the policy definitions or terms and conditions stated. Policyholder files a claim on suicidal case within one year of inception. Therefore, you have to study your policy contract and know your entitlements before you file a claim. 3. How do I make my claims effectively? As a policyholder, one should check the policy contract to determine if you are covered for the event for which you intend to file a claim. Ensure that the policy is inforce by checking your premium payment records. Then, use the necessary claim forms and any other documentary requirements to be completed. Once it is completed, submit the claims with the relevant attachments to your insurance company s claims department. You must be in touch with your agent or contact the customer service department to ensure that your claims are ready to be processed. In case there are insufficient documents, quickly get it done to avoid delay. 4. If I m not satisfied with the rejection or offer of settlement of a claim, what should I do? First, try to resolve your dissatisfaction with the respective insurance company. Kindly refer your case to the Complaint Unit. But if you are still not satisfied with the decision, you can write either to the Financial Mediation Bureau (FMB) or Bank Negara Malaysia (BNM), which will handle your complaint at no charge.

3 Complaints No. Complaint 1. If I have any enquiry or complaint, who should I refer to? If you have any enquiry or complaint on life insurance, kindly refer to the Complaints Unit of insurance companies. If you have any enquiries or interested to find out more about life insurance, you may contact the Customer Service Department of the insurance companies. 2. What is Replacement of Policies (ROP) and what are the disadvantages to policyholders? Replacement of policies happen (ROP) when policy holders surrender their existing policy and replace it with a brand new policy. In the industry, it is commonly known as policy replacement. By committing to a new life policy, there are some consequences to bear. The policyholder may be disadvantaged in some ways. These include higher premium payment required for the new policy as it increases with your age. You may also lose out on some specific policy features and lose out in terms of monetary gains. Clearly, replacement of policies may not benefit the policyholder which in most cases, is certainly not advisable. 3. I recently detected that my customer s life policy had lapsed and replaced with a brand new policy from another insurance company. What shall I do? Kindly inform your Insurance Company about the replacement of policy. Please provide the relevant information that you may have such as: Life assured s name and I/C number Policy owner s name and I/C number Compulsory Status and lapse / termination date of old policy

4 Or Policy number Policy type Optional Sum assured Annual premium of old policy Insurance companies will write to LIAM once they receive complaints on replacement of policy or policies from the agents. The insurance company will conduct the investigation and take necessary action. 4. What should you do if you noticed that your policy had lapsed and replaced with a brand new policy with another insurance company? Kindly inform your Insurance Company about the replacement of policy. You may call the Customer Service Department of your respective insurance company or write in to them IMMEDIATELY to inform about the replacement. Please provide as much information as possible such as new policy number, name of the new policy, policy type, name of the insurance company, sum assured, annual premium of new policy, etc. Your insurance company will write to LIAM once they receive complaints on replacement of policy or policies to request for investigation. They will keep you informed on the investigations results.

5 Insurance Fraud 1. What is insurance fraud? Insurance fraud or takaful fraud is any deliberate deception/dishonesty committed against or by an insurance company or takaful operator, insurance or takaful agent, or consumer for unjustified financial gain. It occurs and may be committed at different points in the transaction by different parties such as policy owners, third-party claimants, intermediaries and professionals who provide services to claimants. The nature of these frauds may vary from an inflated/exaggerated value of a legitimate claim to a completely fabricated or bogus claim where losses never really occurred. Life insurance fraud comes in various forms. Chiefly amongst them are claims fraud in the form of faked injuries/damages, inflated hospital charges, money laundering via purchase of insurance policies with extraordinarily large amounts of money, products/ document tampering or forgery and non-disclosure in customer fact forms.