Utmost Good Faith Binding Between Insured And Insurer Part IV. The insurer has a bigger role in Utmost Good Faith binding both parties namely the insurer and the insured.
Liver Transplant Tragedy
Friday, June 7, 2002, on Singapore Strait Time carried the title ” Transplant tragedy: Heartbreak for wife ‘He died not knowing I was pregnant’ Transplant tragedy: Too much money, Too little time Frantic rush to raise funds. Liver Transplant tragedy” Donor available, but critical delay over cost proves fatal ” No Money, No surgery.
A sorrowful heartbreak story flashing across the local daily newspaper. People cursed the heartless surgeon. The Insurer refused to pay the so-called cash admission in the local private hospital. He later was transferring to another private hospital in Singapore for a liver transplant. The donor was none other than the late patient’s elder sister who sacrificed her own liver and spending the countless sleepless night to raise the fund for her beloved younger brother.
Jaundice
The local hospital diagnosed him suffering from jaundice. He needed to pay admission fee RM5,230.00. The medical card was supposing to be a cashless admission. Finally, the consultant confirmed he suffering from Hepatitis B. Like adding salt to the wound, time delay, patient in critical condition, the ambulance rushed him off to a Singapore private hospital to perform the liver transplant.
No money, no surgery
“First you need to find the right donor for a liver transplant, secondly, S$300,000 full payment as cash deposit before the surgeon can perform the operation.” the hospital concerned informed them, “No money, no surgery”
To cut the story short, the money was raised, the elder sister admitted to hospital for the liver transplant on the following day. Her youngest brother could not hold longer, was called to be with The Lord in the wee hours of the morning.
Whatever is gone, ash to ash dust to dust, but the living need to go on with their life. The deceased family filed a claim for sum insured of RM75,000.00 to the general insurance company for the medical card claim. The shocking reply from a party of the insurer.
Not Claimable
It is with deep regret to inform you that the medical expenses for the treatment of your condition are not claimable under the following policy exclusion:
General Exclusion (11) – ” suicide or attempted suicide, self-inflicted injuries, self-destruction or any attempt thereat while sane or insane. ”
General Exclusion (9) – “… treatment of alcohol dependence syndrome and drug addiction/abuse.”
After countless visiting the hired lawyer, no outcome. But the lawyer charged the family for RM2,000 to open a file. Also, written a numerous of appeal letters to Malaysia Mediation Bureau turn out to be fruitless.
It was a coincidence I stumbled across his sister, after a few chat, only did we realized we were colleagues before. We chatted over a high tea.
” Jamin wong, can you help me to claim my late brother case. Since after we departed, you continue with Chartered insurance study, I am sure and you have the confidence to help me.” she pleaded me.
” Sure, It is my pleasure to help those genuine claim, but those lawyer’s correspondence letter please do not give to me, I want the proposal form, cover note, policy jacket, and rejection claim letter. If I had 90% winning the case, I will write an appeal letter on your behalf to Bank Negar Insurance Mediation Bureau, is that ok with you.
In the proposal form, the brother did write that he was a hepatitis B carrier. Also, there were no exclusion clauses specify in a few years renewal. After close study of the liver specialist’s diagnostic report confirming the patient died of an acute liver failure due to Hepatitis B.
Insurer did not honor Utmost Good Faith
The insured had carried the duty of Utmost Good faith in disclosing he was a hepatitis B carrier in the proposal form. Whereas the insurer did not honor the Utmost Good faith on their part.
Happy Ending
With just one A4 paper size written in the appeal letter. All happy ending . On the 30-7-2004, the widow received a cheque amounting to RM75,000 from the insurer.
Two policies cover the same consignment, small claim response, but bigger sun insured claim was rejected. Another story not follows the Utmost good Faith rule by the insurer, more in the next episode.
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