{"id":9976,"date":"2026-04-29T14:15:00","date_gmt":"2026-04-29T06:15:00","guid":{"rendered":"https:\/\/www.fmos.org.my\/?p=9976"},"modified":"2026-04-29T15:25:55","modified_gmt":"2026-04-29T07:25:55","slug":"failure-to-disclose-pre-existing-medical-condition","status":"publish","type":"post","link":"https:\/\/www.fmos.org.my\/bm\/failure-to-disclose-pre-existing-medical-condition\/","title":{"rendered":"Kegagalan Mendedahkan Keadaan Perubatan Sedia Ada"},"content":{"rendered":"<p class=\"wp-block-paragraph\">Edmund telah didiagnosis dengan batu karang ureter kanan yang bersaiz kecil dan batu karang di buah pinggang kanan dan telah menjalani CT Urogram pada 27 Disember 2022, sebelum polisi berkuat kuasa.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Beliau mengemukakan tuntutan bagi manfaat kemasukan ke hospital, akan tetapi penanggung insurans menolak tuntutan tersebut atas alasan salah nyata fakta material. Fakta-fakta ini tidak didedahkan dalam borang cadangan\/permohonan yang ditandatangani pada 29 Disember 2022, dan penanggung insurans kemudiannya membatalkan polisi dari tarikh permulaan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>PENEMUAN<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Rekod perubatan menunjukkan bahawa CT Urogram dijalankan dua hari sebelum permohonan polisi mengesahkan penemuan buah pinggang yang ketara, dan kemasukan ke hospital selepas itu turut menyokong kewujudan batu karang tersebut. Edmund menjawab \"TIDAK\" kepada soalan mengenai rundingan, penyiasatan, dan keputusan ujian perubatan yang tidak normal dalam tempoh lima tahun yang lalu.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Di bawah Jadual 9 Akta Perkhidmatan Kewangan (FSA) 2013, pencadang dikehendaki mengambil langkah berjaga-jaga yang munasabah semasa menjawab soalan pengunderaitan. Prinsip perundangan Malaysia juga memperuntukkan bahawa sebaik sahaja pencadang menandatangani borang cadangan, mereka terikat dengan kandungannya.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Tiada bukti bahawa Edmund mendedahkan penemuan CT tersebut kepada penanggung insurans atau ejen semasa proses permohonan. Oleh kerana kontrak insurans berasaskan prinsip penuh percaya mutlak, kegagalan membuat pendedahan memberi hak kepada penanggung insurans untuk membatalkan polisi.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>KEPUTUSAN<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Pengurus kes mengekalkan keputusan penanggung insurans dan mendapati bahawa Edmund gagal mendedahkan maklumat perubatan material yang diketahui sebelum polisi bermula. Kegagalan tersebut dianggap disengajakan atau cuai secara melulu dan merupakan salah nyata fakta material.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Penanggung insurans berhak membatalkan polisi selaras dengan terma kontrak dan Jadual 9 FSA 2013. Oleh itu, penolakan tuntutan tersebut dikekalkan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>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 [&hellip;]<\/p>","protected":false},"author":4,"featured_media":9978,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[25,27],"tags":[],"class_list":["post-9976","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-case-studies","category-insurance-takaful"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.8 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Failure to Disclose Pre-Existing Medical Condition - FMOS<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.fmos.org.my\/bm\/failure-to-disclose-pre-existing-medical-condition\/\" \/>\n<meta property=\"og:locale\" content=\"ms_MY\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Failure to Disclose Pre-Existing Medical Condition - FMOS\" \/>\n<meta property=\"og:description\" content=\"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. 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