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My agent is not servicing me anymore! How to make a Medical and Hospitalization Insurance Claim?



We always rely on our insurance agents to service our claims. However, what if your servicing agent is not active in the industry anymore? Do not panic. Please read below.


Knowing what to do and what are your obligations can reduce your stress when making a medical and hospitalization insurance claim. Here are some significant points in regards to claims below:


You (as Policyholder)


- Before you get any treatment, you should call your insurance agent (if you have an agent) or company to check whether the treatment is covered or if the hospital is the panel hospital of the insurance company. Some insurance companies demand you do this.


- Your specialist/doctor will most likely need to fill in and sign your claim form. Your specialist/doctor may charge a little expense, which won't be paid by your insurance company.


- Stay in contact with your insurance agent (if you have any) / company on the status of your claim.


- Your doctor may advice on undergoing a tests or admission to hospital as an in-patient.


- Most hospitals and specialists have their fees paid straightforwardly by the insurance company. Others will send the bills to you.


Your Insurance Company


- Your insurance agent/company will give all of the information you need, affirm what your coverage includes, if needed, they will send you a claim form.


- Your insurance agent/company will reveal to you how the insurance company will pay claims.


In the event that you are diagnosed with a disability that incurs claimable expenses, you ought to do the following:


1. Give written notice to your insurance company as soon as possible, or within 30 days of the treatment received.

2. Attach the following:

- All original bills & receipts

- Full physician’s report

- Physician’s summary of the cost of treatment, and

- Referral letter, if any.

3. Immediately procure and act on proper medical advice as the insurance company shall not be held liable if a treatment or service becomes necessary due to the failure of you to do so.


4. Benefits payable only if all bills for such claims have been submitted and agreed upon by the insurance company.


Your insurance company will consider repaying only the actual costs incurred subject to the your policy limits.


If you have any questions feel free to contact us.


To learn how to claim on life insurance policies, click here.

Source: insuranceinfo.com.my

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