66% of Malaysians say understanding claims and benefits is their top information need. Yet too many agents sell a policy and disappear — leaving you to figure out claims alone. Here's what you need to know and how we do things differently.
How to Claim: Step by Step
Medical Card Claims
01.Get admitted to a panel hospital — present your card at admission.
02.The hospital verifies your coverage and Guarantee Letter (GL) with the insurer.
03.For cashless admission: insurer pays the hospital directly. You pay only the excess/co-payment if applicable.
04.For reimbursement: keep all original receipts, discharge summary, and itemised bill. Submit to your insurer within 30 days.
05.Your agent should guide you through this — including which hospital to go to and what pre-admission steps to take.
Critical Illness Claims
01.Get diagnosed by a registered medical specialist. The diagnosis must match the policy's definition of the illness.
02.Notify your insurer in writing as soon as possible after diagnosis.
03.Submit claim form, specialist report, medical records, and investigation results.
04.The insurer assesses against the policy wording. This is where having an agent who knows the process matters.
05.Once approved, the lump sum is paid directly to you — use it for treatment, income replacement, or whatever you need.
Life Insurance Claims
01.The nominee or next-of-kin files the claim — not the policyholder.
02.Submit: original policy document, death certificate, claimant's IC, claim form.
03.For accidental death: also include police report and post-mortem report.
04.Insurers typically process within 14-30 days of receiving complete documents.
05.Pro tip: make sure your nominee knows about the policy. Many claims go unclaimed because families don't know the policy exists.
Personal Accident Claims
01.Seek medical attention immediately and keep all records.
02.Report the accident to your insurer within the timeframe specified in your policy (typically 30 days).
03.Submit: claim form, medical report, police report (if applicable), and receipts.
04.PA claims can cover medical expenses, temporary disablement (weekly income), permanent disablement (lump sum), and accidental death.
Why Claims Get Denied
Most claim denials are avoidable. The most common reasons:
-Non-disclosure — you didn't tell the insurer about a pre-existing condition when you applied.
-Policy exclusion — the specific condition or treatment isn't covered (check your policy wording).
-Waiting period — most policies have a 30-90 day waiting period for certain conditions.
-Incomplete documentation — missing reports, forms, or receipts.
-Lapsed policy — premiums weren't paid and the policy is no longer active.
-Claim filed late — exceeded the notification deadline in your policy.
What Your Agent Should Do During a Claim
✓Respond to your WhatsApp or call within 24 hours — not "I'll get back to you next week."
✓Walk you through which hospital to go to and what to say at admission.
✓Help you complete the claim forms correctly — one missing field can delay a claim by weeks.
✓Follow up with the insurer on your behalf when processing is slow.
✓Explain the outcome clearly — if a claim is partially approved, tell you exactly why and what your options are.
Our Promise
We don't consider a policy sold until you've successfully claimed on it. When you need us, we answer. We guide you through every step of the claims process — from admission to payout. Because the moment you need to claim is not the moment to discover your agent has disappeared.
The claims process outlined above is a general guide based on common Malaysian insurance practices. Specific procedures, timelines, and requirements vary by insurer and policy type. Always refer to your policy contract for the binding terms and conditions. Great Eastern Life Assurance (Malaysia) Berhad's claims process applies to policies underwritten by them.
Need help with a claim or want an agent who won't disappear? WhatsApp us.