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Claims

Claims – general questions

(for more specific question relating to individual type of claims please scroll down)

GENERAL

What is a suicide clause?
This clause stipulates that no claim is payable in the event of death due to suicide, whether sane or insane, within one year from inception of policy or from date of any reinstatement.

What is contestable period?
Within the first policy year, the insurer has the right to void the policy due to nondisclosure, without the need to prove fraud.

Who can certify claims documents?
Group Sales Manager (GSM) or Unit Sales Manager (USM) may certify all claims documents with the exception of claims incurred outside of Malaysia where the confirmation of the claim event and all other related and relevant documents issued by Foreign Authority must be certified by the Malaysian Embassy or a Public Notary.

If there are foreign documents and claimant is unable to return to Malaysian Embassy of the foreign country to get the documents certified, where can they get the documents to be certified?
The respective country's embassy in Malaysia.

When do you call for the original policy?
With effect from 1 June 2013, policyholders may proceed with claims without submitting the original policy contract. This guideline is revised with the intent to simplify the current process to make hassle free for claims. Nevertheless, the company reserves the right to call for the original policy or supporting documents should the need arises during the processing stage.

How long does it take for the Company to process a claim?
The estimated timeframe to process a claim is within 10 – 14 working days upon receiving the complete claim documents.

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Death Claim

What are the requirements for commonly claimed Death Claims?
Death Claim Form
Certified True Copy of Death Certificate
Certified True Copy of Claimant Identification Card
Certified True Copy of Deceased’s Identification Card
Certified True Copy of Embarkment Certificate
Certified True Copy of Marriage Certificate if Claimant is spouse
Certified True Copy of Birth Certificate of Claimant if Claimant is a child
Certified True Copy of Birth Certificate of Deceased if Claimant is parent
Original copy of Letter of Authorisation/ Consent (3 copies)
Confirmation letter from National Registration Department (for overseas death claims)
Direct Credit Form

Additional requirement on accidental death:
Accidental Death Benefit (ADB) Claim Form
Certified True Copy Police Report
Certified True Copy Detailed Post Mortem Report
Certified True Copy of Toxicology Report, if any
Newspaper Cutting, if any

Death due to nature causes:
Doctor Statement (for policy less than 5 years from date of commencement or from date of reinstatement, whichever is the later)

Important Note:
i) If cause of death is unknown, the Company will advise further on receipt of the Death Certificate
ii) For foreign Death Claims, Certified True Copy full passport book/ Citizenship Certificate are required
iii) For policy without nomination, Grant of Probate/ Letters of Administration is required

If the policy has no nomination, how does Great Eastern pay the claim?
Payment of death claim proceeds for policy where no nomination made is subject to production of Letter of Administration or Grant of Probate.

If there are 3 nominees, how many Letters of Authorization to collect claim(s) payment cheque(s) should be produced?
3 Letters of Authorisation should be produced and to be completed by 3 designated nominees.

If the nominee is in overseas/out of Malaysia, who should complete the Death Claim form?
Nominee still has to complete the Death Claim Form.

Overseas death claim:
what is the difference in documents if body is brought back to Malaysia or buried in overseas? If the body/ashes are brought back to Malaysia, Certified True Copy of Embarkment Certificate issued by the transportation means is required. If the body is buried in overseas, Certified True Copy of the Life Assured confirmation letter of death in overseas from National Registration Department is required to be submitted.

Copy of passport is also required.

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Living Assurance Claim

What are the requirements for commonly claimed Critical Illnesses?
Living Assurance Claim Form – Personal Statement
Confidential Medical Certificate (Cancer)
Confidential Medical Certificate (Brain, Nerve & Muscle related condition) – to be completed by Consultant Neurologist
Confidential Medical Certificate (Heart related condition)
Confidential Medical Certificate (Other illnesses)
Original copy of Letter of Authorisation/ Consent (3 copies)
Certified True Copy of Life Assured’s Identification Card
Certified True Copy of Claimant’s Identification Card (if different from Life Assured)
Certified True Copy of all relevant diagnostic test results or reports for individual
Covered Event (please refer to the list of Covered Events in the Requirement Checklist)
Direct Credit Form

Is there any waiting period?
Yes, commonly waiting period is 30 days to 60 days from the date of risk commencement or date of reinstatement, whichever is later. As different covered event applies different waiting period, please refer to the policy contract for more details.

Is BuyBack Option available for all policies?
No, not all policy provides BuyBack option. Please refer to the terms and conditions of your policy contract.

Living Assurance claim is admitted and it is an Investment Linked policy. If there is any excess premium paid, will it be refunded?
There is no refund for Investment Linked policies. Any excess premium will be added into the Assured’s Total Investment Value fund.

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Total Permanent Disability Claim

What are the requirements for commonly claimed Total Permanent Disability (TPD)?
Total Permanent Disability Claim Form
Total Permanent Disability Medical Certificate Form
Original copy of Letter of Authorisation/ Consent (3 copies)
Certified True Copy of Employment Termination Letter, if applicable
Certified True Copy of Life Assured’s Identification Card
Certified True Copy of Claimant’s Identification Card (if different from Life Assured)
Certified True Copy of Clinic/ Hospital Consultation Card
Certified True Copy of EPF Withdrawal Letter, if applicable
Certified True Copy of SOCSO Offer Letter/ SOCSO “Keputusan Jemaah Doktor Mengenai Keilatan”, if applicable
Certified True Copy of Police Report (accidental cause)
Newspaper cutting (accidental cause), if applicable
Direct Credit Form

If my policy matures on the same date of my 4th instalment, do I have to wait till the 10th year to get full TPD payment?
No, you will get your 4th - 10th instalments on the maturity of the policy.

If it is a third party policy, to whom should the payment be made?
If the Life Assured becomes total permanent disabled, the Assured is the legal policy owner and has the right to receive the payment.

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Accident Claim

What are the requirements for commonly claimed Accident Rider Claims?
Accident Claim Form – Claimant’s Statement
Accident Claim Form – Attending Physician Statement
Original copy of Letter of Authorisation/Consent (3 copies)
Certified True Copy of Life Assured’s Identification Card
Certified True Copy Claimant’s Identification Card (if different from Life Assured)
Original/ Certified True Copy of Medical Certificates
Certified True Copy of Police Report, if applicable
Certified True Copy of X-ray, MRI, CT scan or other radiology reports
Certified True Copy of Hospital Bill(s) and Payment Receipt(s)
Original Bills and Original Payment Receipts (if applicable to reimbursement claims)
Direct Credit Form

Which Attending Physician Statement (APS) to be submitted if the claimant intends to claim for accident claim from both Claim Department and Healthcare Services Department (HSD)?
It is advisable for the claimant to submit the Accident Claim Form - Attending Physician Statement as the information provided is more precise and detailed for Accidental Rider claim assessment.

Is police report necessary for accident claims?
Yes, depending on the nature of the accident i.e. Motor Vehicle Accident (MVA).
For assault/robbery case, police report is mandatory.

If Life Assured’s employer has paid the hospital bill/medical expenses incurred due to the accident, can he still claim with Great Eastern?
If employer pays only part of the bill, balance of the bill can be submitted to Great Eastern for claims assessment. Employer’s confirmation on payment made is required. Original bills are required to be submitted to Great Eastern for balance payment.

If Life Assured is claiming medical expenses with other insurance company, can he still claim with Great Eastern?
If other insurance company pays only part of the bill, balance of the bill can be submitted to Great Eastern for claims assessment. Original proof of settlement and original bills/receipts are required to be submitted to Great Eastern for balance payment.

If the original bill and receipt are lost, can Life Assured claim for medical expenses?
No, medical expenses incurred are on reimbursement basis thus original bill and receipts are required before payment is made.

If Life Assured has claimed medical expenses with Healthcare Services Department (HSD), can he still claim under Life Claim?
If HSD pays only part of the bill, balance of the bill can be submitted to Life Claims for assessment.

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Great Lady Claim (For Childbirth/ Caesarian Claim)

What are the requirements for commonly claimed Great Lady Claims (For Childbirth)?
Certified True Copy Life Assured’s Identification Card
Hospitalisation & Surgical Claim Form – Claimant’s statement
Certified True Copy of child’s birth certificate
Direct Credit Form

What are the requirements for commonly claimed Great Lady Claims (Caesarian Claim)?
Certified True Copy Life Assured’s Identification Card
Hospitalisation & Surgical Claim Form – Claimant’s statement
Certified True Copy of child’s birth certificate
Direct Credit Form
Certified True Copy of hospital bill and doctor to endorse the date, cause & type of surgery performed (applicable to Caesarian claims)

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Great Eastern Holdings Ltd | Great Eastern Life Assurance Co Ltd | Great Eastern General Insurance Ltd
Great Eastern Holdings Ltd | Great Eastern Life Assurance Co Ltd | Great Eastern General Insurance Ltd