Question 1

Who do I contact first to make a claim: the agent, the insurer or the hospital?

Accepted Answer

Tell your agent first, then act on the situation: for hospital admission, show your medical card at a panel hospital so it can request a guarantee letter; for a car accident, report to the police first and then inform the insurer; for death or critical illness, the agent helps you submit to the insurer. If you can’t reach the agent, call the insurer’s hotline.

Question 2

What documents do I need for a claim?

Accepted Answer

It depends on the claim. Common ones are the claim form, the ICs of the life assured and claimant, original medical reports and bills, diagnosis reports, a police report (accidents and car crashes), the death certificate (death claims) and bank account details. Your agent will give you the exact list.

Question 3

Is there a time limit for making a claim?

Accepted Answer

Yes. Every policy sets deadlines for notifying the insurer and submitting claims, for example prompt notice of car accidents and hospital bills within a set number of days. Late claims can be rejected, so inform your agent or insurer as soon as possible.

Question 4

How long does it take to get paid?

Accepted Answer

With complete documents, hospital reimbursements and small claims usually take a few weeks. Death and critical illness claims that need investigation can take longer. Bank Negara sets service standards for claim handling; missing documents are the most common cause of delay.

Question 5

Why does the insurer want my medical records? Do I have to sign an authorisation?

Accepted Answer

The insurer needs to confirm the condition, when it was diagnosed and whether it existed before the policy started. Signing the authorisation lets it request records from hospitals and clinics. This is normal, and without it the claim may not be processed.

Question 6

My claim was rejected. Can I appeal?

Accepted Answer

Yes. Ask the insurer for the reason in writing, then appeal with supporting documents such as a doctor’s report. If still not satisfied, complain to the insurer’s complaints unit and then take the dispute to the Ombudsman for Financial Services (OFS).

Question 7

The insurer says I didn’t disclose a condition, but I genuinely didn’t know I had it. What can I do?

Accepted Answer

If you truly didn’t know about the condition before applying (for example no symptoms and no doctor visits), explain this to the insurer and provide a doctor’s note on when it was diagnosed. The law treats innocent and deliberate non-disclosure differently, and you can take it to OFS if needed.

Question 8

Who can I complain to: the insurer’s complaints unit, OFS or Bank Negara (BNMLINK)?

Accepted Answer

Usually in this order: the insurer’s complaints unit first; if unresolved, refer the claim dispute to the Ombudsman for Financial Services (OFS) within its time limit, which is free for consumers within its scope; service or conduct concerns can also be raised with Bank Negara through BNMLINK or BNMTELELINK.

Question 9

My agent has left. Who helps with my claim?

Accepted Answer

Your policy is between you and the insurer and stays valid. The insurer will assign another agent to service it (an orphan policy), or you can choose a new agent. Lulu can take over and help.

Question 10

Do I keep paying premiums while a claim is being processed?

Accepted Answer

Yes. Unless the policy has ended because of the claim (for example a full death payout) or a premium waiver has been approved, keep paying so the policy doesn’t lapse during the claim.

Question 11

A family member has died and we don’t know what insurance they had. How do we find out?

Accepted Answer

Look through bank and credit card statements, emails and files for premium payments, contact any known agents, or ask insurers directly. Long-unclaimed money is transferred to the Accountant General’s unclaimed moneys system, which can also be searched.

Insurance claims: 11 questions people ask when it matters