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.
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.
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.
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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6 replies to “Utmost Good Faith Binding Between Insured And Insurer Part IV”
You did an awesome job Buddy!
It is people like you who makes this world a better place to live.
Thanks, Buddy. It is everybody duty to make our world a better place to live.
This is such a wonderful concept. Something not a lot of people may not know about. Very helpful information. Great job. Very unique and well written.
It is my pleasure to help others. Thanks for the compliments.
Raymond Huang If you have no money for treatment in a private hospital, you will have no choice but to go to a government hospital. Private hospitals are now commercialised and are profit centered. No money, no talk – that’s it.
Like · Reply · 2 · February 24 at 11:23pm
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Skong Wong Please read the whole story, before you jumped to the conclusion.
Like · Reply · February 24 at 11:24pm
Raymond Huang Sorry. I did not read the whole story. I responded on the heading ‘no money, no surgery …’ Tell us about this unhappy episode where you have given a heading of ‘no money, no surgery, no claim’.
Like · Reply · February 24 at 11:39pm
Skong Wong Do you know what I want to convey here?
Like · Reply · February 24 at 11:43pm
Raymond Huang Tell me.
Like · Reply · February 24 at 11:44pm
Skong Wong Utmost Good Faith Binding Between Insured And Insurer Part
Like · Reply · February 24 at 11:49pm
Skong Wong Red the claim being rejected.
Like · Reply · February 24 at 11:51pm
Raymond Huang Thank you.
Like · Reply · February 24 at 11:53pm
Skong Wong Do you know the outcome ?
Like · Reply · February 24 at 11:58pm
Raymond Huang Good ending
Like · Reply · Yesterday at 12:04am
Skong Wong I love to deal with Insurance claim being rejected by the insurer. I aware that when any claim occurred, the Malaysian always go for the help of a lawyer. The Majority of them has no knowledge of insurance law other than motor liability claim unless the lawyer doing master degree in law with insurance law major.Besides helping the community and it also enhanced my insurance knowledge day by day.
Like · Reply · Yesterday at 12:14am
Raymond Huang Good of you to help the community. Now, what’s happens when the case is deadlocked and you need to file a court case?. Do you give the case to a lawyer with experience in insurance law or you work alongside him in collaboration?
Like · Reply · Yesterday at 12:20am · Edited
Skong Wong I did mention the deceased sister did open a file with a JB lawyer in 2002, but nothing happened until 2004 when the widow received a cheque for full settlement. I did not go to court, nor collaboration with any lawyer. It is a simple A4 paper attacked the loophole of that policy. If you really understand and read through between the line on my post. You will know the clue too. The lawyer did file a case in the court much earlier. In the earlier August when I was there to meet the sibling, the lawyer still not aware the cases being fully settled. He asked for more support documents to file the claim. The sibling told me off. This case was the longest in my claim history, it drags on for almost 6 months by the Insurance Mediation Bureau. I too spent 1 week to go through all the reports, namely Euro Assistance, Local private hospital report, INSURER’S DOCUMENTS, 2 liver specialists reports’ from 2 Singapore hospitals before I typed my argument in an A4 paper.
Like · Reply · 2 · Yesterday at 12:40am
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Simon Poon Insult for the heath care industry and basic human rights.
Like · Reply · 18 hrs · Edited
Thanks for all the insurance forum members for all the valuable comments.