November 16, 2017
Among the many reasons of having a Takaful coverage is to ensure you and your family will not be financially burdened with medical bills should anything happen. However, to fully benefit from a Takaful plan it’s equally important to understand the reasons your Takaful claim might be declined.
In your Takaful contract, make sure you declare all of your existing medical conditions or illnesses. If you think that they won’t know about your previous illness, take note that Takaful operators can obtain your medical report through their claims department who can conduct investigations when a claim is submitted. If they discover that you are making a claim for an existing condition or illness you did not declare, the Takaful company may decide to decline your claim.
Save yourself the hassle and make sure you’re upfront from the beginning.
Takaful coverage may differ between various providers. As such, ensure that you are aware of the inclusions and exclusions so you know what is and is not covered. Be sure to understand the difference between a medical plan and a critical illness plan.
A medical plan will provide coverage in the event of a medical emergency that will require hospitalization. Therefore, this plan will cover in-patient costs including your hospital room and the treatments required. While a critical illness plan means an individual will be provided with financial aid in a lump sum amount within the agreed percentage if diagnosed with a critical illness.
Do ask your Takaful provider or agent to get more clarity on what is covered and what will not be covered within your Takaful plan.
You may have forgotten to make payment for your Takaful plan which would then cause it to lapse. As a result, you will no longer be under the plan’s coverage and you will not be able to make claims. Make sure your Takaful operator has your updated contact details such as your phone number and e-mail as they will usually send you various reminders to make payment when your Takaful plan is about to expire.
Remember that there is an annual limit to every Takaful plan. For example, your Takaful plan has an annual limit of RM100,000. This means you can make claims up to that amount per year. Anything extra will not be claimable and you will need to wait for a renewal the following year to make claims again. Before deciding on a Takaful plan, do look at the annual limit and don’t just focus on the overall lifetime limit which agents and Takaful operators like to highlight.
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Remember, even if you have received your Takaful policy, there is usually a waiting period for some illness and conditions. A waiting period is the length of time after purchasing your Takaful before you can use it to receive coverage. Depending on the condition, the waiting period could differ from a 1 month waiting period to 3 months.
Therefore, if you are making a claim within the waiting period, your claim will be denied. Don’t delay getting you and your family medical coverage because you never know what may happen in the future.
Depending on the Takaful plan, there is a deadline within which you have to submit your claim. Even if you were eligible for that coverage and have all the necessary supporting documents, you claim may be declined if you miss that deadline. Don’t delay sorting out your claims, because procrastinating may cause you to lose out. The timeline could be 3 months from the date of your doctor’s visit. But do get the exact claim timeline from your Takaful plan including how long it will take to process and receive your claim.
The opposite of taking your own sweet time with your claim is rushing through it. Take some time to look through all the forms to ensure you have filled it out correctly. Also, make sure you have included all of the necessary documents required to avoid delays. Be proactive and ask for a list of what is required, then go through it before submitting the claim. Don’t depend on your Takaful agent as they may also overlook certain things.
If your claim was denied on a technical basis, such as you had an error when filing the claim form, or you missed the timeline for claim, you may consider reapplying the claim.
However, if you have tried your best and feel that your claim was denied unfairly, you can get help. This is especially if you believe your situation should have been covered under your policy and if you have evidence to back this up.
You can contact the Ombudsman For Financial Services (OFS) to help you with your case for FREE. OFS is a non-profit organisation set up under the initiative of Bank Negara Malaysia. As an alternative dispute resolution channel for financial consumers in Malaysia, OFS will act as mediator between yourself and your financial services provider. Therefore, if you are not satisfied with your financial service provider’s rejection of your financial claims or the claim amount offered, you can reach out to OFS. But do take note that certain issues does not fall within the jurisdiction of FMB. Below are the financial products and services consumers can seek help for from OFS:
Remember to always keep a copy of whatever documents or receipt you submitted for your Takaful claim. You are usually required to submit the original receipt, so ensure you have made a copy for your own reference in case you need to dispute or there are any problems with your claim.
Finally, remember to review your insurance policy periodically to ensure that it will still be relevant to you. This is because you may want to make revisions to your Takaful plan in order to match your current life stage to ensure you will have adequate coverage.
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