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.
7 Reasons Takaful Claims Are Denied
While getting a Takaful policy is fairly easy, getting your claim approved may not be the case. Just like any other insurances, there have been cases where people got their Takaful claims denied. Read on and find out how to avoid that from ever happening!
Successful Takaful Claims In 7 simple steps
- Always declare ALL existing conditions/illnesses
All of your existing medical conditions or illnesses must be declared upon initial stage of signing up for a Takaful policy. If you’re making a claim for an existing condition/illness you did not declare from the get-go, your claim will most likely be denied.
Don’t ever assume that any information will slip by unnoticed, as investigations are always done thoroughly whenever a claim is submitted.
- Understand ALL the terms of coverage
When it comes to insurance, bear in mind that not all policies are cut from the same cloth. Each insurance has its own unique coverage terms, which is why you must understand all the terms of your coverage.
Here’s a basic take on Takaful plans: The medical plan is only applicable for medical emergencies that requires hospitalization, covering in-patient costs including hospital room and related treatments. The critical illness plan is applicable for medically diagnosed illnesses and unlike medical plan, it doesn’t cover fees specifically. Instead, it comes in the form of financial aid in a lump sum within the agreed percentage.
However, do take note that there might be some conditions/illnesses that your Takaful policy won’t cover. Hence, the best way to understand the coverage terms inside out, is to speak with your Takaful agent and READ your policy thoroughly.
- Take note of annual limits
Your overall lifetime limit may about a million or more, but it doesn't mean you can spend it all at once. This is the misconception many people have, while forgetting the fact that there’s an annual limit.
For example, your Takaful policy has an annual limit of RM50,000. For that one year, RM50,000 is all you can claim regardless of the severity of your case or lifetime limit. In the event you have to claim for anything on top of the RM50,000 limit, it will definitely be denied and you will need to wait for a renewal the following year before you can make claims again.
- Never submit incomplete information
When a misfortune hits yourself or your loved ones, it can be overwhelming and stressful. Due to this, things might be rushed and some information might be left out unintentionally. As a result, your claim might be denied.
Therefore, be calm and take your time when it comes to submitting claims. All the forms might be overwhelming to look at, but with time and patience you’ll eventually get through it. On top of your agent’s help, get a family member or friend to help you through the process too - with more than a pair of eyes, you’ll less likely to miss out any information.
- Never miss the deadline
Though it’s mentioned above that it’s good to take your time in submitting claims, but take note of the submission deadline. It doesn’t matter if you have all the necessary supporting documents for the coverage - once you miss the deadline, it will be denied regardless.
Since submission deadlines vary with different Takaful policies, always double check your own deadline while making claims.
- Take note of the waiting period
What is a waiting period? It is the length of time after obtaining your Takaful policy, before you can utilize its coverage. Depending on the situation, waiting periods could vary between 1 month to 3 months.
Which means, any claim made within the waiting period will definitely be denied. Therefore, it’s advisable to get coverage as early as possible to avoid unnecessary waiting time for future needs.
- Never skip payments
This final step is the most crucial of them all… never skip payments!
We understand there might be days when your budget is a little tight for the month, or you’d even forget to pay. However, when it comes to something as important as insurance, you should always prioritize it. This is crucial as the stakes are high - your Takaful policy might lapse and all claims will be denied.
Just imagine forking out thousands of Ringgit or even more in the event of any misfortune - and it’s all because you skipped just a few payments. That would defeat the purpose of having a policy in the first place, wouldn’t it?
If budget’s your issue, you could dedicate a monthly savings account just for insurance purposes. That way, you won’t be spending the money meant for Takaful. Alternatively, speak to your Takaful agent and change to a lower tier policy which you can afford for now.
If forgetfulness is the problem, it’s even easier! Just ensure that your contact details are updated to receive payment reminders OR alternatively, set automatic billing direct from your bank.
What to do, if all else fails
If you missed one of the steps above and got your claim denied, try to redo and re-apply. However, if you had done everything needed and yet your claim is still denied, reach out to Ombudsman For Financial Services (OFS) for help!
Aimed to help consumers 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. Below are the financial products and services OFS can help you with:
Also, remember to keep a copy of ALL documents submitted for Takaful claim. Original receipts are usually needed, therefore make a copy for your own reference in case there’s an issue with your claim. Better be safe than sorry!
With these simple steps, your Takaful claims will most likely be approved successfully. However, even if it’s denied OFS is here to help. So there’s actually no need to worry too much!
Share this with your family and friends who own Takaful policies as well, so that they'll also know what to do in the future.