Insurance Claim Rejected? Here’s Who Can Help

Having your insurance claim rejected by your insurer is not something many of us have encountered – fortunately. And those who have will tell you that it isn’t something they hope to have to go through again – ever.

The processes that one must undertake to overturn the decision is not for the faint-hearted. At this point, even the most reliable agent may no longer have the power or perseverance to assist. So you are entirely on your own in dealing with the insurer. Making calls after calls and being passed from one officer to another.

The process is long and if you ever wanted to have your patience tested, this would be a great place for it. And all this without any sort of guarantee that you will triumph in the end. It’s no wonder that many gave up half way.

Giving up may not be a big deal if the claim amount is relatively small. But what if it involves a large sum such as a payout for a death or permanent disability claim? Would you be willing to give up especially when knowing you are totally entitle to it.

For such cases, there are a few things that you can do, which includes taking the issue to relevant parties such as Bank Negara Malaysia and PIAM (Persatuan Insurans Am Malaysia), as covered in our past article.

Another way that we will be covering in detail here is through Ombudsman for Financial Services.

Who is Ombudsman for Financial Services?

Ombudsman for Financial Services (OFS) – formerly known as Financial Mediation Bureau, was incorporated on 30th August 2004 and commenced its operations on 20th January 2005.

According to OFS from its main website, it is a non-profit organisation set up under the initiative of Bank Negara Malaysia (BNM) as an alternative complaint/ dispute resolution channel to resolve complaints/ disputes between its members who are Financial Service Providers (FSPs) licensed or approved by BNM and their customers.

Members of Ombudsman for Financial Services (OFS)

OFS’ members include:
– Licensed banks as well as Islamic banks
– Licensed insurers and takaful operators
– Prescribed development financial institutions (such as Agrobank and SME Bank)
– Approved designated payment instrument issuers as well as Islamic payment instrument issuers
– Approved insurance and takaful brokers
– Financial advisors and Islamic financial advisors

Before taking your dispute against your insurer/ takaful operator to OFS, make sure that it is part of OFS’ list of members. Get the full list here.

The scope of OFS in complaints/ disputes resolution

Part of OFS’  mandate is to offer the consumers free and effective resolution of complaints/ disputes arising from products and services provided by their members. For complains/ disputes relating to insurance and takaful, the types of disputes/ complaints under the jurisdiction of OFS includes:

Complaints/ disputes on motor third party property damage insurance/ takaful claims: RM 10,000

Other complaints/ disputes relating to insurance/ takaful: RM 250,000

Exceptions

These are a few exceptions that are not covered under OFS’ jurisdiction that are worth taking note of:

1. A complaint/ dispute that is beyond the maximum monetary limit as stated above
2. A complaint/ dispute that has been filed in a court or arbitration or referred to arbitration or has been decided by a court or arbitrator
3. Complaint/ dispute that is referred to OFS after more than six months from the date the member has provided its final decision
4. A complaint/ dispute that had been previously decided by the OFS unless new evidence, which are material facts that could change the earlier decision, is available for the OFS’ consideration
5. A complaint/ dispute involving claims arising from a third party bodily injury or death
6. Complaint/ dispute relating to the payment of the policy moneys under life policy and personal accident policy or payment of takaful benefits under family takaful certificate and personal accident takaful certificate

For the complete list of OFS’ scope and jurisdiction, refer to OFS’ website here.

How to file a complaint/ dispute with OFS

OFS advises that consumer to first try to resolve the issue with their insurance or takaful operator. If the parties are unable to come to an amicable settlement, the consumer is then advised to lodge a complaint or dispute with OFS.

There are two ways to file your complaints/ disputes:

(i) within six months from the date of the final decision issued by the insurer or takaful operator who is a member of OFS

or

(ii)  after sixty calendar days from the date of your complaint/ dispute was first referred to the insurer/ takaful operator in respect of which no response has been received from them

Here are several ways in which you can lodge your complain/ dispute:

1. Write in via post

Chief Executive Officer
Ombudsman for Financial Services
(Formerly known as Financial Mediation Bureau)
14th Floor, Main Block
Menara Takaful Malaysia
No. 4, Jalan Sultan Sulaiman
50000 Kuala Lumpur. ​

2. Write in via fax

Chief Executive Officer

Fax number: +603-2272 1577

3. Walk-in

Ombudsman for Financial Services
(Formerly known as Financial Mediation Bureau)
14th Floor, Main Block
Menara Takaful Malaysia
No. 4, Jalan Sultan Sulaiman
50000 Kuala Lumpur. ​

4. Write in via web can be done here.

Before filing a complaint or dispute with OFS, we advise that our readers to first contact OFS to fully understand the procedures and documents/ information that they may require to process the complaint/ dispute. They are reachable at 603-2272 2811.