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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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FMB/LI 0012 Time for giving Notice of Disability
The insurers declined the assured's claim for total and permanent disability benefit on the ground that notice of the disability was not given within 6 months of the disability as required by the policy. The assured's daughter who submitted the claim on behalf of the assured contended that the failure to submit the claim within the time frame stipulated in the policy was because the assured did not inform her or other family members of the existence of the policy.
In Law of Life Insurance in Malaysia by S Santhana Dass it is stated as follows :
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" When the time for giving notice of loss is fixed by the terms
of the policy, it must be strictly complied with. Surrounding
circumstances would not be taken into account to explain a
delay by the insured in giving notice of loss to the insurer "
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The policy had been in existence since 27.12.1989 and the Mediator found it quite peculiar that the assured had never informed the family members of the existence of the policy. It is stated in Law of Life Insurance by S Santhana Dass that " it is the duty of all policyowners not only to read the terms and conditions …… but also to make sure that all the terms and conditions are strictly complied with. Policyowners should also have a further duty to advise their family members on the procedure in the event of illness, disability or death. Failure to comply with the terms and conditions of the policy would result in their inability to recover or enjoy the benefits under the policy ".
Since there was a failure to comply with policy condition which requires notice of disability to be given to the insurer within 6 months of the disability, the Mediator confirmed the insurers' decision in repudiating liability on the claim.
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