LIAM Clarifies Insurance Agents' Limited Role in Medical Claims Processing

The Life Insurance Association of Malaysia (LIAM) clarified that insurance agents function primarily as intermediaries between insurers and policyholders, without a formal role in the medical claims process. While agents often assist policyholders by relaying information or helping them navigate the claims procedure, case management and claim decisions are handled internally by designated officers within insurance companies. This clarification addresses a common misconception among policyholders who expect agents, who sell policies and receive commissions, to be directly involved in claims processing and dispute resolution. However, access to claims personnel is controlled by individual insurers and is not guaranteed to claimants. Policyholders may find it challenging to identify or contact claims officers, as insurance companies rarely publish staff directories or provide direct contact information. LIAM emphasizes that while agents and insurers assist during the claims process, claim rejection or disputes can be escalated to the Financial Markets Ombudsman Services (FMOS), which offers an independent dispute resolution service. FMOS intervention occurs only after formal denial of a claim, not when claims are under review or delayed due to requests for additional documentation. Recent cases, such as that of a cancer patient awaiting claim approval for months, highlight challenges in claims processing timelines and insurer investigations into unrelated medical history. Although agents are named in insurance contracts with identification details, their formal relationship with policyholders typically ends after policy sale, similar to real estate agents. Nonetheless, agents sometimes continue to assist policyholders beyond the sale, including gathering documents or providing support during claims reviews. This delineation of roles underscores the need for clear communication in the insurance industry regarding agent responsibilities and the claims process structure. It also spotlights the importance of transparency and timely claims processing to maintain policyholder trust and regulatory compliance.