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Case Review: Insurance
Summary of some of the decisions made by the Mediators on some of the complaints received by FMB.
This summary is for information only and should not be used for other purpose.
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IMB/3701 - Commencement of Policy Coverage
The claimant was covered under a group hospital & surgical insurance policy taken by his employer (the insured). He was hospitalized on 10.10.2003 and submitted a claim for reimbursement of medical expenses incurred. The insurers declined the claim on the ground that coverage for the claimant only commenced on 18.12.2003. The insurers' decision was based on Endorsement D008 of the policy which was issued upon specific instruction from the insured that coverage for the claimant was to commence on 18.12.2003.
The policy was issued with the following provision: "employees are automatically covered upon acceptance of appointment from the insured…". The claimant was appointed by the insured on 12.8.2003. Thus by virtue of the policy provision he would be covered by the policy with effect from 12.8.2003. However there was a specific instruction from the insured to provide coverage for the claimant with effect from 18.12.2003 and an endorsement (D008) was issued accordingly.
In Insurance Law in Malaysia By Nik Ramlah Mahmood, it is stated as follows (at page 153):-
"Because the standard policies and forms attempt to cater for the general needs of a particular branch of insurance while the typewritten or handwritten additions cater to the specific needs of a particular insured and a particular policy, there can arise situation where one is inconsistent or in direct conflict with the other. The general rule in the case of such an inconsistency or conflict is that the typewritten or handwritten provisions should override the printed provisions. In such a situation, greater weight is given to a written or typewritten rather than to a printed clause because the written or typewritten words are the immediate language and terms selected by the parties themselves…"
In the matter under reference Endorsement D008 will override the standard policy provision as it represents the specific intention of the parties. In the circumstances the Mediator confirmed the insurers' decision in repudiating liability on the claim.
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