We all know the importance of having an insurance policy to cover for unexpected circumstances such as accidents, sickness, third party liability etc and we expect the insurance company to come to our aid when we encounter such trouble.
We may not have read through the entire policy wording, and even if we do, we may not fully understand all the terms and exclusion clauses. Therefore, there will be situation where we think it should be claimable, but may be declined by the insurer.
In such situation, of course we will communicate with the claim department and try to have them look from our perspective, while they look at the insurance contract wording.
There may be time where your claim are allowed, but may not be as per your expectation. What can you do then?
First, Lodge an official complaint with the Complaint Department
If you cannot convince the claim department and not happy with the decision, it is best to move to the next department, ie the Complaint Department. Every Insurance company will have their complaint department to look at each complaint. Let another group of professionals to look into your grievance.
If this still does not satisfy you, you next step is look for Ombudsman for Financial Services (OFS)
Second, Seek help from OFS
The Ombudsman for Financial Services is appointed by Bank Negera Malaysia as the official operator of the financial ombudsman scheme, giving them the authority to resolve financial disputes between financial consumers and financial service providers (FSP). The ombudsman works as an independent person who’s responsible for investigating and resolving disputes between you and your financial provider, in this case, your insurer.
You can only turn to OFS for mediation after you have file an official complaint to the insurer. Once you case has been accepted and reviewed by the mediator, a recommendation/decison will be provided. Any recommendation/decision provided by OFS is legally binding to the insurers, but not you. Meaning that if the recommendation is to award claim of RM X amount, if accepted by you, it is legally binding to the insurer, but if the recommendation is not accepted by you. You may proceed to pursue your case to Court.
Last Resort – Take the Insurer to Court
The court is the last resort you can pursue to look into your grievance. You will need to engage a lawyer to take up your case.