Insurance Claim Rejected in Malaysia: How to File with BNM BNMLINK

Insurance Claim Rejected in Malaysia: Know Your Rights and Next Steps

Receiving a rejection letter from your insurance company is stressful, especially when you were counting on that payout during a medical crisis, accident, or financial hardship. The good news: Malaysia has a robust regulatory framework that gives policyholders real power to fight back. Bank Negara Malaysia (BNM) — the country's central bank and insurance regulator — takes consumer complaints seriously, and insurers know it.

This guide explains exactly what to do after your claim is rejected, from filing an internal appeal to escalating to BNM BNMLINK and the Ombudsman for Financial Services (OFS).

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Understanding Why Claims Get Rejected in Malaysia

Malaysian insurers commonly deny claims for these reasons:

• Non-disclosure: You failed to declare a pre-existing condition when purchasing the policy
• Exclusion clauses: The condition or incident falls under policy exclusions
• Lapsed policy: Premiums were not paid and the policy had lapsed at the time of the claim
• Waiting period: Claim made during the policy's initial waiting period (commonly 30–60 days for health insurance)
• Documentation gaps: Incomplete or missing supporting documents
• Misrepresentation: Details in the claim form conflict with medical records

Crucially, a rejection is not final. Under Malaysian law and BNM guidelines, you have defined rights to appeal — and independent parties can overrule your insurer.

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Step 1: Request the Rejection Letter and Full Policy Document

Within 3 days of receiving your rejection, contact your insurer in writing and request:

1. The full written explanation for the rejection, citing specific policy clauses
2. A copy of your complete policy document (if you don't already have one)
3. All documents the insurer relied on when making their decision

Under BNM's Guidelines on Claims Settlement Practices, insurers must provide a clear, written reason for any rejection. If they refuse to provide this, that itself is a regulatory violation you can report.

Keep all correspondence — emails, letters, and WhatsApp messages — as evidence.

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Step 2: File a Formal Internal Complaint

Before escalating to regulators, you must give the insurer a chance to resolve the dispute internally. Most insurers have a 30-day internal resolution deadline under BNM's Framework for Internal Dispute Resolution.

How to file your internal complaint:

• Write formally to the insurer's complaints department (not just your agent)
• State clearly that you are disputing the rejection and want a formal review
• Attach any new evidence: additional medical reports, doctor statements, or documents that were missing from the original claim
• Send by registered mail or email with read receipt — you need proof of delivery

Address your letter to the Chief Compliance Officer or Head of Claims, not just general customer service. This creates a formal paper trail.

What to Include in Your Appeal Letter

• Your policy number and full name
• Date of claim submission and date of rejection
• Specific grounds for your appeal (e.g., "The policy does not exclude this condition under Clause 4.3")
• Supporting documents (new medical evidence, second opinions, hospital records)
• A clear statement of what outcome you are requesting

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Step 3: Escalate to BNM BNMLINK (If Unresolved in 14 Days)

If the insurer does not resolve your complaint within 14 days (or issues a response you disagree with), you can escalate to Bank Negara Malaysia through the BNMLINK portal.

BNMLINK Contact Details:

• Online portal: bnmlink.bnm.gov.my
• Phone: 1-300-88-5465 (1-300-88-LINK)
• Walk-in: Level 1, BNM Tower, Jalan Dato Onn, Kuala Lumpur
• Operating hours: Monday to Friday, 9am–5pm

When filing through BNMLINK, provide:

• Your complaint reference number from the insurer
• The insurer's rejection letter
• Your internal appeal letter and any response received
• Your policy number and claim reference

BNM will acknowledge your complaint and engage the insurer on your behalf. This regulatory pressure often leads to settlements without needing to go further.

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Step 4: File with the Ombudsman for Financial Services (OFS)

If BNM BNMLINK does not resolve your dispute, or if your claim value exceeds what BNM handles directly, escalate to the Ombudsman for Financial Services (OFS) — previously known as the Financial Mediation Bureau.

OFS Key Details:

• Website: www.ofs.org.my
• Phone: 03-2272 2811
• Email: enquiry@ofs.org.my
• Claim limit: OFS can adjudicate claims up to RM 250,000 for most disputes (higher for certain motor claims)
• Cost: The service is free for consumers

OFS operates independently of the insurance industry and can order insurers to pay out claims. Their decisions are binding on the insurer (though you can still choose to pursue court action if you disagree with their ruling).

OFS Timeline

• Initial assessment: within 14 days
• Investigation and mediation: typically 60–90 days
• Adjudication (if mediation fails): up to 6 months for complex cases

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Step 5: Consider Legal Action as a Last Resort

If your claim exceeds RM 250,000 or if you disagree with the OFS ruling, you may pursue civil litigation. Malaysia's courts have been increasingly consumer-friendly in insurance disputes, particularly where insurers have acted in bad faith or relied on ambiguous policy language.

Consult a lawyer who specializes in insurance disputes. Under the Malaysian Contracts Act 1950 and Insurance Act 1996, courts apply the contra proferentem rule — ambiguous policy language is interpreted against the insurer who drafted it.

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Common Mistakes That Hurt Malaysian Insurance Appeals

1. Waiting too long to appeal. Most policies require you to appeal within 30–60 days of rejection. Check your policy document for specific deadlines.

2. Appealing only verbally. Phone calls are not formal complaints. Always follow up in writing.

3. Going straight to court. Courts in Malaysia typically require you to exhaust internal and OFS channels first. Skipping these steps wastes time and money.

4. Accepting a lowball settlement too quickly. Insurers sometimes offer partial payments to close cases. Get everything in writing and compare it to what your policy actually entitles you to.

5. Not getting additional medical evidence. If the rejection was based on a medical assessment, a second opinion from a specialist can significantly strengthen your appeal.

6. Forgetting to document your insurer communications. In disputes, the insurer may claim they never received something. Use registered mail and email with delivery confirmation.

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Key Regulatory Timelines to Know

Stage	Deadline
Insurer must acknowledge complaint	3 working days
Insurer internal resolution	14 working days
BNM BNMLINK engagement	Within 14 days of escalation
OFS initial assessment	14 days
OFS full investigation	60–90 days

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Your Rights Under Malaysian Law

Under the Financial Services Act 2013 and BNM's consumer protection guidelines, you have the right to:

• Receive a written explanation for any claim rejection
• Appeal within a reasonable period
• Access an independent ombudsman at no cost
• Have ambiguous policy language interpreted in your favor
• Receive compensation for unreasonable delay in claim processing

BNM also publishes an annual report on insurer complaint handling, and insurers with high complaint ratios face regulatory scrutiny — which gives them strong incentive to resolve disputes fairly.

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Writing Your Appeal Letter

A strong appeal letter makes a significant difference. Your letter should be structured, evidence-based, and cite specific policy clauses. Avoid emotional language and focus on the contractual and factual arguments.

If you're not sure how to structure your appeal, ClaimBack can generate a professional, evidence-based appeal letter tailored to Malaysian insurance regulations and your specific rejection reason. Visit claimback.app to get started — it takes less than 5 minutes.

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Summary: Your The Full Fight

1. Get the rejection in writing with specific policy clause citations
2. File a formal internal appeal within your policy's deadline (typically 30 days)
3. Escalate to BNM BNMLINK if unresolved after 14 working days
4. File with OFS for independent adjudication on claims up to RM 250,000
5. Seek legal advice for high-value claims or OFS ruling disputes

Malaysia's insurance regulatory system genuinely protects consumers. The key is acting quickly, communicating in writing, and escalating systematically through the proper channels.