{"id":9982,"date":"2026-04-29T14:28:37","date_gmt":"2026-04-29T06:28:37","guid":{"rendered":"https:\/\/www.fmos.org.my\/?p=9982"},"modified":"2026-04-29T15:24:22","modified_gmt":"2026-04-29T07:24:22","slug":"travel-medical-claim-dispute-over-pre-existing-condition","status":"publish","type":"post","link":"https:\/\/www.fmos.org.my\/bm\/travel-medical-claim-dispute-over-pre-existing-condition\/","title":{"rendered":"Pertikaian Tuntutan Perubatan Perjalanan Mengenai Keadaan Sedia Ada"},"content":{"rendered":"<p class=\"wp-block-paragraph\">Lucy telah dimasukkan ke hospital akibat Hiponatremia (paras natrium darah rendah) ketika sedang melancong ke luar negara. Beliau mengemukakan tuntutan bagi perbelanjaan perubatan di bawah polisi insurans perjalanannya. Walau bagaimanapun, penanggung insurans menolak tuntutan tersebut atas dasar kemasukannya disebabkan oleh keadaan perubatan yang sedia ada, yang dikecualikan di bawah polisi tersebut.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>PENEMUAN<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Polisi tersebut dengan jelas menyatakan bahawa penanggung insurans tidak akan bertanggungjawab atas sebarang tuntuutan yang timbul daripada keadaan kesihatan yang sedia ada yang telah berlaku dalam tempoh satu tahun sebelum perjalanan, termasuk keadaan yang memerlukan rawatan, ubat-ubatan, atau menunjukkan simptom yang akan menyebabkan seseorang yang munasabah mendapatkan rawatan perubatan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Berdasarkan klausa ini, penanggung insurans merujuk kepada rekod hospital yang menunjukkan bahawa Lucy telah mengambil Losartan bersama Hydrochlorothiazide (HCTZ), sejenis ubat yang berkaitan dengan paras natrium yang rendah. Atas dasar ini, pananggung insurans membuat kesimpulan bahawa kemasukannya ke hospital adalah berkaitan dengan keadaan sedia ada dan oleh itu perlindungan insurans dikecualikan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Walau bagaimanapun, Lucy menjelaskan bahawa paras natrium rendah yang menyebabkan beliau dimasukkan ke hospital berpunca daripada muntah berterusan, pengambilan makanan yang tidak mencukupi, dan jangkitan saluran pernafasan atas yang dialaminya semasa perjalanan, bukannya disebabkan oleh ubat jangka panjang yang diambilnya.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Susulan sesi mediasi, dua surat penjelasan daripada hospital mengenai rawatan beliau telah diperolehi. Kedua-dua surat tersebut mengesahkan bahawa paras natrium Lucy adalah normal selama bertahun-tahun semasa mengambil HCTZ dan episod tersebut lebih berkemungkinan disebabkan oleh muntah akut dan pengambilan cecair yang tidak mencukupi sepanjang perjalanan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>KEPUTUSAN<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Berdasarkan penjelasan perubatan tersebut, kami mendapati bahawa kemasukan Lucy ke hospital bukan disebabkan oleh keadaan sedia ada. Memandangkan penanggung insurans memikul beban untuk membuktikan bahawa pengecualian polisi terpakai, dan gagal membuktikannya dalam kes ini, pengecualian tersebut tidak boleh digunakan.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Selaras dengan prinsip insurans yang telah ditetapkan dan terma polisi, Ombudsman membuat keputusan yang memihak kepada Lucy.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>","protected":false},"excerpt":{"rendered":"<p>Lucy was on an overseas trip when she was hospitalised for Hyponatremia (low sodium blood level). She submitted a claim for medical expenses under her travel insurance. However, the insurer rejected the claim on the basis that her admission was caused by a pre-existing medical condition, which was excluded under the policy. FINDINGS The policy [&hellip;]<\/p>","protected":false},"author":4,"featured_media":9984,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[25,27],"tags":[],"class_list":["post-9982","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>Travel Medical Claim Dispute Over Pre-Existing 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\/travel-medical-claim-dispute-over-pre-existing-condition\/\" \/>\n<meta property=\"og:locale\" content=\"ms_MY\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Travel Medical Claim Dispute Over Pre-Existing Condition - FMOS\" \/>\n<meta property=\"og:description\" content=\"Lucy was on an overseas trip when she was hospitalised for Hyponatremia (low sodium blood level). She submitted a claim for medical expenses under her travel insurance. However, the insurer rejected the claim on the basis that her admission was caused by a pre-existing medical condition, which was excluded under the policy. FINDINGS The policy [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.fmos.org.my\/bm\/travel-medical-claim-dispute-over-pre-existing-condition\/\" \/>\n<meta property=\"og:site_name\" content=\"FMOS\" \/>\n<meta property=\"article:published_time\" content=\"2026-04-29T06:28:37+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-04-29T07:24:22+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png\" \/>\n\t<meta property=\"og:image:width\" content=\"500\" \/>\n\t<meta property=\"og:image:height\" content=\"501\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/png\" \/>\n<meta name=\"author\" content=\"commsadmin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"commsadmin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minit\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#article\",\"isPartOf\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/\"},\"author\":{\"name\":\"commsadmin\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/8fbea4ebb5130d485f32d0731efd4689\"},\"headline\":\"Travel Medical Claim Dispute Over Pre-Existing Condition\",\"datePublished\":\"2026-04-29T06:28:37+00:00\",\"dateModified\":\"2026-04-29T07:24:22+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/\"},\"wordCount\":322,\"publisher\":{\"@id\":\"https:\/\/www.fmos.org.my\/en\/#organization\"},\"image\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png\",\"articleSection\":[\"Case Studies\",\"Insurance\/ Takaful\"],\"inLanguage\":\"ms-MY\"},{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/\",\"url\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/\",\"name\":\"Travel Medical Claim Dispute Over Pre-Existing Condition - FMOS\",\"isPartOf\":{\"@id\":\"https:\/\/www.fmos.org.my\/en\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png\",\"datePublished\":\"2026-04-29T06:28:37+00:00\",\"dateModified\":\"2026-04-29T07:24:22+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#breadcrumb\"},\"inLanguage\":\"ms-MY\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"ms-MY\",\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage\",\"url\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png\",\"contentUrl\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png\",\"width\":500,\"height\":501},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.fmos.org.my\/en\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Travel Medical Claim Dispute Over Pre-Existing Condition\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#website\",\"url\":\"https:\/\/www.fmos.org.my\/en\/\",\"name\":\"FMOS\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/www.fmos.org.my\/en\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.fmos.org.my\/en\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"ms-MY\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#organization\",\"name\":\"FMOS\",\"alternateName\":\"Financial Markets Ombudsman Services\",\"url\":\"https:\/\/www.fmos.org.my\/en\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ms-MY\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/FMOS_hori-logo_fullcolor-Custom.png\",\"contentUrl\":\"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/FMOS_hori-logo_fullcolor-Custom.png\",\"width\":262,\"height\":50,\"caption\":\"FMOS\"},\"image\":{\"@id\":\"https:\/\/www.fmos.org.my\/en\/#\/schema\/logo\/image\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/8fbea4ebb5130d485f32d0731efd4689\",\"name\":\"commsadmin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"ms-MY\",\"@id\":\"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/a05f4bcfd9343a8f8d132e42c78c8681f5478a61135065e2d36ad22020b81651?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/a05f4bcfd9343a8f8d132e42c78c8681f5478a61135065e2d36ad22020b81651?s=96&d=mm&r=g\",\"caption\":\"commsadmin\"},\"url\":\"https:\/\/www.fmos.org.my\/bm\/author\/commsadmin\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Travel Medical Claim Dispute Over Pre-Existing Condition - FMOS","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.fmos.org.my\/bm\/travel-medical-claim-dispute-over-pre-existing-condition\/","og_locale":"ms_MY","og_type":"article","og_title":"Travel Medical Claim Dispute Over Pre-Existing Condition - FMOS","og_description":"Lucy was on an overseas trip when she was hospitalised for Hyponatremia (low sodium blood level). She submitted a claim for medical expenses under her travel insurance. However, the insurer rejected the claim on the basis that her admission was caused by a pre-existing medical condition, which was excluded under the policy. FINDINGS The policy [&hellip;]","og_url":"https:\/\/www.fmos.org.my\/bm\/travel-medical-claim-dispute-over-pre-existing-condition\/","og_site_name":"FMOS","article_published_time":"2026-04-29T06:28:37+00:00","article_modified_time":"2026-04-29T07:24:22+00:00","og_image":[{"width":500,"height":501,"url":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png","type":"image\/png"}],"author":"commsadmin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"commsadmin","Est. reading time":"2 minit"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#article","isPartOf":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/"},"author":{"name":"commsadmin","@id":"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/8fbea4ebb5130d485f32d0731efd4689"},"headline":"Travel Medical Claim Dispute Over Pre-Existing Condition","datePublished":"2026-04-29T06:28:37+00:00","dateModified":"2026-04-29T07:24:22+00:00","mainEntityOfPage":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/"},"wordCount":322,"publisher":{"@id":"https:\/\/www.fmos.org.my\/en\/#organization"},"image":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage"},"thumbnailUrl":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png","articleSection":["Case Studies","Insurance\/ Takaful"],"inLanguage":"ms-MY"},{"@type":"WebPage","@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/","url":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/","name":"Travel Medical Claim Dispute Over Pre-Existing Condition - FMOS","isPartOf":{"@id":"https:\/\/www.fmos.org.my\/en\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage"},"image":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage"},"thumbnailUrl":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png","datePublished":"2026-04-29T06:28:37+00:00","dateModified":"2026-04-29T07:24:22+00:00","breadcrumb":{"@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#breadcrumb"},"inLanguage":"ms-MY","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/"]}]},{"@type":"ImageObject","inLanguage":"ms-MY","@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#primaryimage","url":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png","contentUrl":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/AR-Case-Studies-19.png","width":500,"height":501},{"@type":"BreadcrumbList","@id":"https:\/\/www.fmos.org.my\/travel-medical-claim-dispute-over-pre-existing-condition\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.fmos.org.my\/en\/"},{"@type":"ListItem","position":2,"name":"Travel Medical Claim Dispute Over Pre-Existing Condition"}]},{"@type":"WebSite","@id":"https:\/\/www.fmos.org.my\/en\/#website","url":"https:\/\/www.fmos.org.my\/en\/","name":"FMOS","description":"","publisher":{"@id":"https:\/\/www.fmos.org.my\/en\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.fmos.org.my\/en\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"ms-MY"},{"@type":"Organization","@id":"https:\/\/www.fmos.org.my\/en\/#organization","name":"FMOS","alternateName":"Financial Markets Ombudsman Services","url":"https:\/\/www.fmos.org.my\/en\/","logo":{"@type":"ImageObject","inLanguage":"ms-MY","@id":"https:\/\/www.fmos.org.my\/en\/#\/schema\/logo\/image\/","url":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/FMOS_hori-logo_fullcolor-Custom.png","contentUrl":"https:\/\/www.fmos.org.my\/wp-content\/uploads\/2026\/04\/FMOS_hori-logo_fullcolor-Custom.png","width":262,"height":50,"caption":"FMOS"},"image":{"@id":"https:\/\/www.fmos.org.my\/en\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/8fbea4ebb5130d485f32d0731efd4689","name":"commsadmin","image":{"@type":"ImageObject","inLanguage":"ms-MY","@id":"https:\/\/www.fmos.org.my\/en\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/a05f4bcfd9343a8f8d132e42c78c8681f5478a61135065e2d36ad22020b81651?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/a05f4bcfd9343a8f8d132e42c78c8681f5478a61135065e2d36ad22020b81651?s=96&d=mm&r=g","caption":"commsadmin"},"url":"https:\/\/www.fmos.org.my\/bm\/author\/commsadmin\/"}]}},"_links":{"self":[{"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/posts\/9982","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/comments?post=9982"}],"version-history":[{"count":2,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/posts\/9982\/revisions"}],"predecessor-version":[{"id":10007,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/posts\/9982\/revisions\/10007"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/media\/9984"}],"wp:attachment":[{"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/media?parent=9982"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/categories?post=9982"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.fmos.org.my\/bm\/wp-json\/wp\/v2\/tags?post=9982"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}