PETALING JAYA: Policyholders have legal grounds to take insurers to court for failing to honour claims or delaying letters of guarantee for cancer treatment, says veteran lawyer M. Manoharan.
He said that in principle, an insurance contract is a binding agreement. When a company refuses a payout without proper justification, the policyholder has the right to challenge it in court.
However, he cautioned that the process is tedious.
"Litigation is time-consuming and time is something a cancer patient cannot afford to waste.
"They can sue the insurer for breaching the contract, but the priority should be treating the deadly disease first," he told The Star.
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"Court battles move slowly, and hearings can drag on for months or even years. If they eventually win the case, it may be purely academic if they succumb to the illness before the judgment.
"On the other hand, if they lose, they may be slapped with additional financial losses, including legal fees for their lawyer and possibly for the insurer," he added.
Manoharan said patients should focus on securing treatment and regaining their health before considering legal action.
He said often, patients are emotionally and financially drained during treatment, and this can be made worse when they have to attend court for a lawsuit they filed.
Manoharan, who has undertaken many such cases, cited one he handled in Seremban involving a stroke patient whose claim was rejected by the insurer on the grounds of pre-existing health conditions.
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He said that after months of negotiations and mounting stress for the family, the insurer eventually agreed to an out-of-court settlement and paid the claim.
"We need a system that is fairer, faster, and more compassionate. Insurance companies must urgently iron out these problems so as not to unnecessarily stress out patients with terminal illnesses.
"The government must intervene to ensure fairness and that policyholders are not left fighting alone for treatment they should be entitled to," he said.
Manoharan suggested that to address the problem, the government could consider introducing a national health insurance scheme that provides healthcare coverage to all Malaysians who are afflicted with major illnesses.
"It can be a smaller coverage with affordable premiums and perhaps co-payments as well.
"This will benefit every layer of society, and nobody will be left behind when it comes to healthcare," he said.
It was reported on Tuesday (Nov 4) that the Health Ministry is in discussions with Bank Negara and the Finance Ministry concerning the delays or denials of insurance claims for cancer patients.
The ministry added that it was also exploring ways to strengthen patient protection.
The National Cancer Society OF Malaysia (NCSM) has claimed that ideal cancer treatment options for insured patients are being delayed, with insurance companies ignoring clinical needs and dictating terms, including downgrading medical procedures.
NCSM managing director Prof Dr M. Murallitharan said some patients are often caught in a quandary when insurers question recommended procedures by doctors, withholding approvals or demanding further justification before critical treatment can proceed.
