These case studies have been modified so as not to identify any actual cases at FIDReC. They are provided for purposes of learning and are not necessarily indicative of outcomes at FIDReC.
Ray, a Singapore Permanent Resident, purchased a hospitalisation plan in 2015. Due to family and work commitments, Ray made frequent trips between Malaysia and Singapore. He spent half his time in each country.
In 2023, Ray sustained an injury in Singapore but sought treatment at a Malaysian hospital. He filed a claim with the Insurer. The Insurer asked Ray why he had been hospitalised overseas. Ray explained his living arrangements to the Insurer.
The Insurer later rejected Ray’s claim. The Insurer stated that Ray had failed to meet the residency clause. This clause required the policy holder not to have resided outside of Singapore for more than 180 days in a policy year. The Insurer highlighted that this clause came into effect following the policy renewal in 2020. The Insurer had notified Ray of this clause by letter one month before the policy renewal.
Ray disagreed with the claim rejection. While he had received the Insurer’s letter, he did not notice the residency clause. It was one of many amendments made to the Policy in 2020. Had the Insurer brought the specific clause to his attention, he would not have continued with the policy as he would no longer have been eligible for its benefits. Moreover, he highlighted that this clause was detrimental to him. He would now have to apply for a replacement policy and may not be able to get coverage on similar terms.
As Ray and the Insurer could not agree, Ray came to FIDReC. At mediation, Ray acknowledged that he should have noticed the residency clause during the 2020 policy renewal. But he felt that it was unfair that an insurer could insert a clause that would render him ineligible for the policy benefits.
The Insurer explained that introducing the residency clause was a standard practice across the industry. The Insurer shared some of the business reasons that led to introducing the clause. The Insurer also pointed to the terms of the insurance contract. The contract allowed the Insurer to make amendments to the policy if they notified policyholders by writing to them before renewal.
After further discussions with the mediator, the Insurer agreed to make a gesture of goodwill. Considering Ray’s unique circumstances, including how the 2020 residency clause would deprive him of any benefit under the policy, the Insurer agreed to refund Ray the premiums he had paid since 2020. Ray accepted this offer.
Key Learning Points
- Many insurance contracts have clauses that allow insurers to amend the terms and conditions of their policies. This includes varying premiums and adjusting the scope and coverage of the policy.
- The insurer must usually notify the policyholder before these amendments come into effect. Insurers will often do so by way of post or email. You should be mindful of any such notifications.
- Clarify with your insurer if you are unsure of the implications of any amendment.
- You have the responsibility to keep your contact information with your financial institutions up to date. Please do so to avoid missing any crucial notifications.
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