Edmund had been diagnosed with a right mild ureteric stone and right renal stone and had undergone a CT Urogram on 27 December 2022, before the commencement of the Policy.

He filed a claim for hospitalisation benefits, but the insurer rejected it on the grounds of misrepresentation of material facts. These facts were not disclosed in the proposal/application form signed on 29 December 2022, and the insurer subsequently voided the Policy from inception.

PENEMUAN

Medical records showed that a CT Urogram conducted two days before policy application confirmed significant renal findings, and later, admissions further supported the presence of kidney stones. Edmund answered ‘NO’ to questions regarding consultations, investigations, and abnormal medical test results within the past five years.

Under Schedule 9 of the Financial Services Act (FSA) 2013, a proposer must exercise reasonable care when answering underwriting questions. Malaysian legal principles also provide that once a proposer signs the proposal form, they are bound by its contents.

There was no evidence that Edmund disclosed the CT findings to the insurer or agent during the application process. As insurance contracts are founded on the principle of utmost good faith, non-disclosure entitles the insurer to void the Policy.

KEPUTUSAN

The case manager upheld the insurer’s decision, concluding that Edmund failed to disclose material medical information known before the Policy commenced. The omission was considered deliberate or reckless and amounted to misrepresentation of material facts.

The insurer was entitled to void the Policy in accordance with the terms of the contract and Schedule 9 of the FSA 2013. The rejection of the claim was therefore sustained.