Insurance Claim Appeal Letter Malaysia: BNM-Aligned Template

Insurance Claim Appeal Letter Malaysia: BNM-Aligned Template

When an insurer in Malaysia denies your claim, your first and most important action is to submit a well-structured formal appeal. A letter that references Bank Negara Malaysia (BNM) guidelines, cites the correct policy provisions, and is addressed to the appropriate internal channel has a significantly higher chance of success than an informal complaint.

This guide provides a complete BNM-aligned appeal letter template and explains how to escalate to the Ombudsman for Financial Services (OFS) if the internal appeal fails.

Malaysia's Insurance Regulatory Framework

Insurance in Malaysia is regulated by Bank Negara Malaysia (BNM), Malaysia's central bank and integrated financial regulator. The key legislation governing insurance contracts is the Financial Services Act 2013 (FSA) and its Islamic finance equivalent, the Islamic Financial Services Act 2013 (IFSA). The Consumer Protection Act 1999 also applies in certain insurance contexts.

BNM has issued numerous guidelines on market conduct, fair dealing, and claims handling. Insurers licensed by BNM are required to maintain a Customer Service Unit (CSU) and an internal complaints process.

The Ombudsman for Financial Services (OFS) at ofs.org.my is Malaysia's independent dispute resolution body for insurance and financial services complaints. It is free for consumers and handles claims up to RM 250,000.

The Formal Internal Complaint: Your First Step

Before approaching BNM or OFS, you must file a formal written complaint with the insurer. BNM guidelines require insurers to:

• Acknowledge your complaint within 5 working days
• Resolve your complaint or provide a substantive response within 14 working days (extendable to 30 working days for complex cases with notice to you)

Always use the insurer's formal complaints channel — typically the Customer Service department or the designated Complaints Officer — rather than your agent or broker. An agent is not the appropriate recipient for a formal complaint.

BNM-Aligned Appeal Letter Template

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[Your Full Name] [Your NRIC Number / Passport Number] [Your Address] [Your Email Address] [Your Contact Number] [Date]

Head of Customer Service / Complaints Department [Name of Insurance Company] [Insurer's Address]

Re: Formal Appeal — Claim Denial — Policy No. [XXXXXXXXX] — Claim No. [XXXXXXXXX]

Dear Sir/Madam,

1. Introduction and Purpose

I am writing to formally appeal the decision of [Insurance Company Name] dated [date] to deny my insurance claim under Policy No. [XXXXXXXXX], Claim No. [XXXXXXXXX]. I respectfully submit that this decision is incorrect and inconsistent with the terms of my policy and the consumer protection standards established by Bank Negara Malaysia (BNM).

I request a full and impartial review of my claim in accordance with your internal complaints and appeal process.

2. Policy and Claim Details

• Policyholder: [Your Name]
• Policy Number: [XXXXXXXXX]
• Claim Number: [XXXXXXXXX]
• Type of Policy: [Life / Medical / Motor / Travel / Property — as applicable]
• Date of Incident / Claim Event: [Date]
• Date of Claim Submission: [Date]
• Date of Denial Letter: [Date]
• Amount Claimed: RM [Amount]

3. Summary of Denial and Grounds for Appeal

Your denial letter of [date] states that my claim has been declined on the following grounds:

[Quote the exact denial reasons from the insurer's letter]

I respectfully submit that this denial is incorrect for the following reasons:

3.1 [First Denial Ground]

The denial states that [quote reason]. However, I respectfully disagree because:

[Provide your counter-argument. Reference the specific policy clause that supports coverage. For example: "Clause 7.1 of the Policy Wording defines a 'Medical Emergency' as... My condition satisfies this definition as confirmed by the attached medical report from [Hospital / Doctor Name] dated [date]."]

3.2 [Second Denial Ground — if applicable]

[Repeat for each additional denial ground.]

4. Supporting Documents Enclosed

The following documents are enclosed in support of this appeal:

1. Copy of Policy Schedule and Policy Wording
2. Copy of Denial Letter dated [date]
3. [Medical report / hospital bill / police report / photographs / repair estimate — list all]
4. [Other relevant documents]

5. Reference to BNM Consumer Protection Standards

I note that under BNM's Guidelines on Minimum Standards for Handling Unresolved Consumer Complaints, insurers are required to handle consumer complaints with fairness and transparency. I further note that under the Financial Services Act 2013 and BNM's Fair Dealing Framework, insurance companies are obligated to treat customers fairly and to apply policy terms in a clear and reasonable manner.

I respectfully submit that the denial of my claim, as detailed above, does not comply with these standards because [explain briefly — for example: "the exclusion relied upon was not prominently disclosed at the time of policy purchase" or "the policy language is ambiguous and should be interpreted in my favour"].

6. Required Action and Timeline

I request that [Insurance Company Name]:

1. Conduct a thorough and impartial review of my claim and this appeal
2. Overturn the denial and approve my claim for the full amount of RM [amount]
3. Provide your written response within 14 working days of receipt of this letter, in accordance with BNM guidelines

If I do not receive a satisfactory resolution within the stipulated timeframe, I will escalate this matter to:

• Ombudsman for Financial Services (OFS): ofs.org.my
• Bank Negara Malaysia BNMTELELINK: 1-300-88-5465 or complaints@bnm.gov.my

Yours faithfully,

[Your Full Name] [Your NRIC Number] [Your Signature]

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Escalating to the OFS (Ombudsman for Financial Services)

If your internal appeal is rejected or not resolved within 30 working days, you can escalate to the Ombudsman for Financial Services (OFS) at ofs.org.my.

OFS key facts:

• Free for consumers
• Handles disputes up to RM 250,000
• Covers life, general, and takaful insurance
• Both mediation and adjudication services available
• Decisions binding on the insurer (not on the consumer)

What to prepare for OFS:

• Copy of your internal appeal letter
• Copy of the insurer's final response (or evidence of non-response)
• All policy documents, denial letters, and supporting evidence
• A one-page summary of the dispute and your desired outcome

OFS timeline: Mediation typically takes 2 to 4 months; adjudication may take 6 to 12 months for complex cases.

Escalating to BNM BNMTELELINK

You may also file a report with BNM BNMTELELINK (1-300-88-5465 or bnmtelelink@bnm.gov.my) if you believe the insurer has engaged in regulatory misconduct, systemic unfair dealing, or breached the Financial Services Act. BNM does not adjudicate individual claims but can take supervisory action against non-compliant insurers.

Dos and Don'ts for Malaysian Insurance Appeals

Do:

• Send by email to create a timestamp and paper trail
• Keep copies of everything
• Reference specific policy clauses, not just general complaints
• Enclose all supporting evidence at the outset
• Set a clear deadline for response
• Mention OFS and BNM as your escalation paths

Don't:

• Threaten legal action without basis
• Use emotional language instead of factual arguments
• Address your complaint to your agent (they are not the complaints channel)
• Wait too long — OFS time limits apply
• Submit vague complaints without specific policy clause references

Using ClaimBack for Malaysia Insurance Appeals

ClaimBack at claimback.app generates professionally structured insurance appeal letters for Malaysia and other markets. Whether your claim involves health insurance, life insurance, motor insurance, or travel insurance, ClaimBack produces a letter that references the correct policy clauses, BNM guidelines, and presents your case in the format most likely to succeed with the insurer's complaints team and, if necessary, with OFS.

Conclusion

A professionally drafted, BNM-aligned appeal letter is your strongest weapon in reversing an insurance claim denial in Malaysia. Use the template above as your starting point, tailor it to your specific circumstances with supporting evidence, and submit it to the insurer's formal complaints channel. If the insurer does not respond satisfactorily, escalate to OFS at ofs.org.my without delay.