Penanggung insurans Malaysia tidak boleh membatalkan tuntutan perubatan berdasarkan ketidakdedahan keadaan sedia ada?

Di Malaysia, penanggung insurans boleh membatalkan tuntutan perubatan atau polisi berdasarkan ketidakdedahan keadaan sedia ada. Kerangka undang-undang untuk tindakan ini terutamanya diwujudkan di bawah Akta Perkhidmatan Kewangan (FSA) 2013 dan Akta Insurans 1996.

Peruntukan Undang-undang Utama

Kewajipan Pendedahan: Sebelum memeterai kontrak insurans, pemohon mesti mendedahkan semua fakta penting. Fakta penting ialah apa-apa sahaja yang akan mempengaruhi keputusan penanggung insurans untuk menerima risiko atau menentukan kadar premium.

Pemulihan untuk Ketidakdedahan: Di bawah Jadual 9 FSA 2013, jika pemohon gagal mengambil "penjagaan munasabah" untuk tidak membuat salah nyata, penanggung insurans boleh:

Membatalkan kontrak sepenuhnya (melayannya seolah-olah ia tidak pernah wujud).

Menolak atau mengurangkan tuntutan.

Menamatkan kontrak atau mengubah termanya.

Nuansa Penting Sehingga 2025

Pengecualian Keadaan Pra-Sedia Ada: Kebanyakan pelan perubatan swasta di Malaysia secara eksplisit mengecualikan keadaan pra-sedia ada (penyakit yang mana gejala atau rawatannya berlaku sebelum polisi bermula).

Penafian yang Tidak Munasabah: Sehingga Disember 2025, Bank Negara Malaysia (BNM) telah menekankan bahawa penanggung insurans tidak boleh menangguhkan atau menafikan tuntutan secara tidak munasabah atau mengenakan pengecualian yang tidak dinyatakan dengan jelas dalam dokumen polisi.

Pemeriksaan Perubatan: BNM tidak mewajibkan pemeriksaan perubatan sebelum pembelian polisi; walau bagaimanapun, ini meletakkan tanggungjawab ke atas pengguna untuk bersikap jujur ​​dan teliti semasa permohonan.

Pendedahan Tanpa Rasa Tidak Bersalah: Jika anda benar-benar tidak mengetahui tentang sesuatu keadaan (cth., ia tidak didiagnosis dan bebas gejala), ia mungkin tidak dianggap sebagai pelanggaran kewajipan. Walau bagaimanapun, "kealpaan" atau "kecuaian" dalam mengisi borang biasanya bukan pembelaan yang sah.

Apa yang Perlu Dilakukan Jika Tuntutan Ditolak

Jika tuntutan ditolak disebabkan oleh dakwaan tiada pendedahan tentang keadaan sedia ada, anda boleh:

Rayuan kepada Penanggung Insurans: Meminta justifikasi terperinci untuk penolakan tersebut.

Hubungi Ombudsman Perkhidmatan Kewangan (OFS): Jika rayuan dalaman gagal, anda boleh memfailkan pertikaian dengan OFS, yang menyediakan penyelesaian pertikaian bebas untuk pengguna kewangan.

Kemukakan Aduan dengan Bank Negara Malaysia: Laporan layanan tidak adil boleh dibuat melalui BNM Telelink.

Tindak balas AI mungkin termasuk kesilapan. Untuk nasihat undang-undang, rujuk profesional.

Malaysian insurers cannot void medical claim base on non-disclosure of pre-existing conditions?

In Malaysia, insurers can void a medical claim or a policy based on the non-disclosure of pre-existing conditions. The legal framework for these actions is primarily established under the Financial Services Act (FSA) 2013 and the Insurance Act 1996. 

Key Legal Provisions

• Duty of Disclosure: Before entering into an insurance contract, applicants must disclose all material facts. A material fact is anything that would influence an insurer's decision to accept the risk or determine the premium rate.

• Remedies for Non-Disclosure: Under Schedule 9 of the FSA 2013, if an applicant fails to take "reasonable care" not to make a misrepresentation, the insurer may:

  • Void the contract entirely (treat it as if it never existed).

  • Refuse or reduce a claim.

  • Terminate the contract or change its terms. 

Important Nuances as of 2025

• Pre-Existing Condition Exclusions: Most private medical plans in Malaysia explicitly exclude pre-existing conditions (illnesses for which symptoms or treatment occurred before the policy began).

• Unreasonable Denials: As of December 2025, Bank Negara Malaysia (BNM) has emphasized that insurers cannot unreasonably delay or deny claims or apply exclusions that were not clearly stated in policy documents.

• Medical Check-Ups: BNM does not mandate medical check-ups before policy purchase; however, this places the responsibility on the consumer to be honest and thorough during application.

• Innocent Non-Disclosure: If you genuinely did not know about a condition (e.g., it was undiagnosed and symptom-free), it may not be considered a breach of duty. However, "forgetfulness" or "carelessness" in filling out forms is typically not a valid defense. 

What to Do if a Claim is Rejected

If a claim is rejected due to alleged non-disclosure of a pre-existing condition, you can:

1. Appeal to the Insurer: Request a detailed justification for the rejection.

2. Contact the Ombudsman for Financial Services (OFS): If the internal appeal fails, you can file a dispute with the OFS, which provides independent dispute resolution for financial consumers.

3. Lodge a Complaint with Bank Negara Malaysia: Reports of unfair treatment can be made via BNM Telelink. 

AI responses may include mistakes. For legal advice, consult a professional. 

喺馬來西亞，保險公司可以根據未披露先前存在嘅病症，令醫療索償或保單無效。呢啲行動嘅法律框架主要係根據2013年金融服務法（ FSA ）同1996年保險法建立。

重點法律條文

披露義務：喺簽訂保險合約之前，申請人必須披露所有重要事實。重要事實係指任何會影響保險公司決定接受風險或者決定保費率嘅嘢。

唔披露嘅補救方法：根據 FSA 2013嘅附表9，如果申請人未能採取「合理嘅注意」唔作出虛假陳述，保險公司可以：

完全廢除合約（將佢當係從來都冇存在過）。

拒絕或者減少索償。

終止合約或者改變合約條款。

截至2025年嘅重要細節

現有病症排除條件：馬來西亞大部分私人醫療計劃都明確排除現有病症（喺保單開始之前出現症狀或治療嘅疾病）。

無理拒絕：截至 2025 年 12 月，馬來西亞國家銀行（ BNM ）強調保險公司唔可以無理延遲或拒絕索償，或者適用保單文件中未明確列明嘅排除條件。

醫療檢查： BNM 唔要求喺購買保單之前進行醫療檢查；但係，呢個就令消費者有責任喺申請過程中誠實同徹底。

無辜唔披露：如果你真係唔知某個病（例如，嗰個病係未被診斷同冇症狀），噉可能唔會被視為違職。但係，填表嗰陣「唔記得」或者「唔小心」通常唔係一個有效嘅辯護。

如果申索被拒絕，點算好

如果申索因為涉嫌未披露先前存在嘅病症而被拒絕，你可以：

向保險公司上訴：要求提供詳細嘅拒絕理由。

聯絡金融服務監察員（ OFS ）：如果內部上訴失敗，你可以向 OFS 提出爭議，佢提供

為金融消費者獨立解決爭議。

向馬來西亞國家銀行提出投訴：有關不公平待遇嘅報告可以透過 BNM Telelink 提出。

人工智能嘅回應可能包括錯誤。如需法律建議，請諮詢專業人士。

Modern human clinical trials are strictly regulated to prevent cruelty and minimize risks, though serious or 

irreversible damage remains a rare but documented possibility. 

Risk of Irreversible Damage

While most trials involve only minor, temporary discomfort, participants can face life-altering risks: 

• Serious Complications: In rare instances, experimental treatments have caused permanent injury, organ failure, or death.

• Irreversible Outcomes: Certain trials, such as those involving invasive procedures or new genetic therapies, carry inherent risks of lasting physical effects (e.g., changes in bone density or fertility).

• Unpredicted Toxicity: Approximately 30% of clinical drug development failures are due to unmanageable toxicity discovered during human testing. 

Is it Considered "Cruel"?

Ethically conducted trials are not legally or professionally defined as "cruel" because they require voluntary participation and informed consent. However, some critics and patient advocates use the term "cruelty" to describe specific systemic issues: 

• Exclusionary Criteria: Patients with terminal illnesses may view rigid trial entry requirements as "cruel" because they are denied access to potentially life-saving experimental treatments.

• Ethical Lapses: Historically, "cruel" experiments (like those leading to the Nuremberg Code) occurred without consent. Today, any trial that fails to provide adequate medical care or uses placebos when standard life-saving treatments exist is considered a violation of human rights. 

Safeguards to Prevent Harm

To prevent unethical practices, modern research is governed by:

• Institutional Review Boards (IRBs): These committees must approve every trial to ensure the potential benefits outweigh the risks.

• Informed Consent: Participants must be told all known risks and have the right to withdraw at any time.

• Strict Monitoring: Trials are halted immediately if unacceptable risks or serious adverse events are detected. 

For information on active trials and their safety profiles, you can search the official ClinicalTrials.gov database

Modern human clinical trials are strictly regulated to prevent cruelty and minimize risks, though serious or 

irreversible damage remains a rare but documented possibility. 

Risk of Irreversible Damage

While most trials involve only minor, temporary discomfort, participants can face life-altering risks: 

• Serious Complications: In rare instances, experimental treatments have caused permanent injury, organ failure, or death.

• Irreversible Outcomes: Certain trials, such as those involving invasive procedures or new genetic therapies, carry inherent risks of lasting physical effects (e.g., changes in bone density or fertility).

• Unpredicted Toxicity: Approximately 30% of clinical drug development failures are due to unmanageable toxicity discovered during human testing. 

Is it Considered "Cruel"?

Ethically conducted trials are not legally or professionally defined as "cruel" because they require voluntary participation and informed consent. However, some critics and patient advocates use the term "cruelty" to describe specific systemic issues: 

• Exclusionary Criteria: Patients with terminal illnesses may view rigid trial entry requirements as "cruel" because they are denied access to potentially life-saving experimental treatments.

• Ethical Lapses: Historically, "cruel" experiments (like those leading to the Nuremberg Code) occurred without consent. Today, any trial that fails to provide adequate medical care or uses placebos when standard life-saving treatments exist is considered a violation of human rights. 

Safeguards to Prevent Harm

To prevent unethical practices, modern research is governed by:

• Institutional Review Boards (IRBs): These committees must approve every trial to ensure the potential benefits outweigh the risks.

• Informed Consent: Participants must be told all known risks and have the right to withdraw at any time.

• Strict Monitoring: Trials are halted immediately if unacceptable risks or serious adverse events are detected. 

For information on active trials and their safety profiles, you can search the official ClinicalTrials.gov database

Modern human clinical trials are strictly regulated to prevent cruelty and minimize risks, though serious or 

irreversible damage remains a rare but documented possibility. 

Risk of Irreversible Damage

While most trials involve only minor, temporary discomfort, participants can face life-altering risks: 

• Serious Complications: In rare instances, experimental treatments have caused permanent injury, organ failure, or death.

• Irreversible Outcomes: Certain trials, such as those involving invasive procedures or new genetic therapies, carry inherent risks of lasting physical effects (e.g., changes in bone density or fertility).

• Unpredicted Toxicity: Approximately 30% of clinical drug development failures are due to unmanageable toxicity discovered during human testing. 

Is it Considered "Cruel"?

Ethically conducted trials are not legally or professionally defined as "cruel" because they require voluntary participation and informed consent. However, some critics and patient advocates use the term "cruelty" to describe specific systemic issues: 

• Exclusionary Criteria: Patients with terminal illnesses may view rigid trial entry requirements as "cruel" because they are denied access to potentially life-saving experimental treatments.

• Ethical Lapses: Historically, "cruel" experiments (like those leading to the Nuremberg Code) occurred without consent. Today, any trial that fails to provide adequate medical care or uses placebos when standard life-saving treatments exist is considered a violation of human rights. 

Safeguards to Prevent Harm

To prevent unethical practices, modern research is governed by:

• Institutional Review Boards (IRBs): These committees must approve every trial to ensure the potential benefits outweigh the risks.

• Informed Consent: Participants must be told all known risks and have the right to withdraw at any time.

• Strict Monitoring: Trials are halted immediately if unacceptable risks or serious adverse events are detected. 

For information on active trials and their safety profiles, you can search the official ClinicalTrials.gov database