Complaints on Life Insurance

Many people are at a loss when it comes to applying for a health and life insurance policy. A critical illness cover is no different. This type of insurance provides a single, lump sum payout should the insured become critically ill or injured as defined in the policy’s language.

But there is a catch: insurance companies do not just grant critical illness cover to any or everyone who applies.

Taking out a critical illness insurance might not be the most pleasing thing to go shopping for, but at least it’s practical, especially if your mortgage or business depends on you being fit enough to work.

The premise is that you’ll receive a payout from your insurer, depending on how much you pay them, for a diagnosis of a critical illnesses within six core areas: heart attack, kidney failure, major organ transplants, multiple sclerosis, stroke and cancer.

So imagine how you’d feel if you did get cancer, but your insurer said it didn’t count – which is what happened to Sally Wong*.

In addition to being told she has cancer, Sally also found out she’s not going to receive any of the financial support she thought she’d paid for after being diagnosed with an early form of breast cancer called Ductal Carcinoma In Situ (DCIS).

This is when a non-malignant tumour has been found, which has the potential to become malignant and spread, but because it’s caught early it is still contained.

Sally took two critical illness policies out with an insurance company in 2001, costing RM500 a month and was diagnosed with DCIS in March 2006, and it was explained to her that her form of cancer, while still in the “in situ” phase, was also high-grade and therefore likely to become invasive. If this was allowed to happen, she would stand a low chance of survival.

She was given immediate surgery to remove the lump, followed by radiotherapy treatment to reduce the chance of the cancer spreading. An important factor in ensuring against this was to rest and recuperate. Fortunately, Sally had taken out a critical illness policy to protect her from having to work.

Or so she thought.

An impossible situation
Sally’s claim was rejected because the type of cancer she had was excluded from her policy. The insurance company told her that the medical information for her illness did not support a valid claim.

She recalls: “When I read the policy, not knowing very much about cancer, I thought of it as one disease – I didn’t know it comes in different forms – and I didn’t know what in-situ meant. It was explained to me that it was a type of cancer that hasn’t progressed to the type that could kill me – yet – and they don’t cover you for this.”

Sally took her case up to the Finance Ministry, but they told her they felt that the documentation was clear, and therefore were unable to uphold her complaint against the insurance company.

The women that get DCIS are put in an impossible position – they need to have the necessary treatment to remove it before it invades, but in doing so won’t receive the money they need, because their critical illness policy only covers them if it spreads.

That means if the cancer hadn’t been detected, and had spread, she could have received a payout.

Instead, Sally was forced back to work soon after her first diagnosis – and unfortunately was diagnosed with DCIS again in December 2007.

“When I was told I had in-situ again I thought to myself, ‘I can’t afford to have this – what’s my family going to do’? I felt desperate – I was told I needed months off work. You even end up thinking if it had invaded, at least I wouldn’t be a financial burden,” she added.

Because it had returned, they took no chances and removed the breast completely. However, complications with her skin healing following the mastectomy led Sally to need a further eight operations, leaving her physically unable to work.

“I feel that I’ve never fully gained my strength and can only do a fraction of what I could before I had my mastectomy. It’s a disabling amputation – one that leaves you totally incapacitated – but I’m never going to get any money.”

A standard practice
The fact is, it’s a standard practice across the industry to exclude carcinomas in-situ – cancers that haven’t yet invaded surrounding tissue. Insurers maintain they’re only able to offer cover for the conditions which are generally considered to be immediately life-threatening – and because screenings for breast cancer find cancers before they reach a life-threatening stage, they say this means they don’t count it as a critical illness.

An insurance agent who declined to be named offered this explanation, “Cancer in-situ is specifically excluded from the critical illness cover offered by many insurance companies because there’s a good possibility that cancer at this early stage will respond to treatment.

“All customers are given a ‘key facts’ document which lists the high level conditions that are covered by our policy, but not all types of these conditions are covered. This document also tells customers where to find full descriptions of the conditions covered.

“We’re committed to ensuring that our customers understand what they’re buying and we feel it’s up to the whole industry, including insurance companies and advisers, to help customers understand their cover.”

It all seems very unjust to Sally who said, “One type of insurance is telling me I don’t have a critical illness but when I want to take out holiday insurance they won’t cover me because my condition is considered critical. Is it not critical that you have a breast removed? I’ll die if I don’t. That’s pretty critical in my book.”

Azlina Firzah Abd Aziz, consultant breast surgeon at the Pantai Medical Centre (Breast Care Centre) sheds some light on the ways insurance companies work.

“Carcinoma in-situ is a growth that is in the original site and although it hasn’t broken through the lining, it does not mean it is not cancer. It just means that it has not gone beyond the point of origin.

“It is still cancer. What I don’t understand is insurance companies not covering carcinoma in-situ.”

On breast cancer, she said, there are also some insurance companies which say that claims are only accepted for advance stage breast cancer – not even stage one or two is accepted for claims.”

*Not her real name