Tokio Marine Insurance Claim Denied in Singapore: How to Appeal

Tokio Marine Insurance Claim Denied in Singapore: How to Appeal

Tokio Marine is one of Japan's oldest and largest insurance groups, with a significant presence in Singapore through Tokio Marine Life Insurance Singapore Ltd. and Tokio Marine Insurance Singapore Ltd. (general insurance). Tokio Marine Singapore offers Integrated Shield Plans (TM Shield), life insurance, critical illness cover, personal accident insurance, travel insurance, and motor insurance.

If Tokio Marine has denied your insurance claim in Singapore, you have rights under Singapore's insurance regulatory framework to challenge the decision through internal complaints, the LIA Singapore Claims Conciliation Panel, and FIDREC.

About Tokio Marine Singapore

Tokio Marine Singapore's protection products include:

Tokio Marine Life Insurance Singapore:

• TM Shield — Integrated Shield Plan covering public and private hospital care above MediShield Life
• TM Term Life and TM Whole Life plans
• Critical illness plans (early and advanced stage)
• Disability income plans
• Savings and endowment plans

Tokio Marine Insurance Singapore (General Insurance):

• Motor insurance
• Travel insurance
• Personal accident insurance
• Home and property insurance

Common Tokio Marine Denial Reasons

TM Shield (ISP) denials:

• No pre-authorisation for planned procedures: Tokio Marine requires pre-authorisation for elective hospitalisations and most surgical procedures. Without it, claims are routinely denied or significantly reduced.
• Non-panel specialist: Using a specialist not on Tokio Marine's panel may reduce coverage.
• Medical necessity disputed: Tokio Marine's medical team may contest whether the admitted procedure or treatment was medically necessary.
• Excluded conditions: Congenital conditions, cosmetic treatment, self-inflicted injuries, and psychiatric conditions are typically excluded.

Life and critical illness denials:

• Non-disclosure of medical history: Tokio Marine may allege you failed to disclose relevant medical conditions or history at application.
• Critical illness definition not met: Tokio Marine's CI definitions require specific clinical criteria — your diagnosis may be disputed as not meeting the exact definition.
• Contestability: During the first 2 years, Tokio Marine can contest claims for misrepresentation.

Travel insurance denials:

• Pre-existing conditions not disclosed or covered
• Cancellation reasons not covered by the policy
• Insufficient documentation for claims

Personal accident and motor denials:

• Disputed cause of accident or injury
• Policy exclusions (driving under influence, intentional acts)
• Valuation disputes for vehicle damage

Your Singapore Rights When Tokio Marine Denies a Claim

MAS regulation: Tokio Marine Life Insurance Singapore and Tokio Marine Insurance Singapore are both licensed and regulated by the Monetary Authority of Singapore (MAS).

LIA Singapore: Life and critical illness disputes can be referred to the LIA Claims Conciliation Panel for free mediation.

FIDREC: For unresolved complaints, FIDREC provides independent adjudication binding on Tokio Marine (for cases within FIDREC's jurisdiction limits).

General Insurance Association (GIA) Singapore: For general insurance disputes (motor, travel, personal accident), the GIA provides industry guidance and may be able to assist with resolution.

Step-by-Step: How to Appeal a Tokio Marine Denial

Step 1: Understand the Denial

Review Tokio Marine's written denial notice and identify:

• The specific denial reason
• The policy clause cited
• Your appeal rights and any deadlines

Step 2: Review Your Policy Documents

Download your full policy document from the Tokio Marine customer portal or request it directly. Focus on:

• The specific product's conditions (Shield, CI, travel)
• Definitions of covered events and conditions
• Exclusions relevant to your claim
• Claims procedures and conditions

Step 3: Gather Medical or Other Evidence

For health/ISP claims:

• Hospital discharge summary, itemised bill, and procedure notes
• Treating doctor's letter explaining medical necessity
• Pre-authorisation records (or emergency justification)

For critical illness claims:

• Specialist's letter specifically addressing whether your diagnosis meets Tokio Marine's policy definition (cross-reference the exact definition from the policy document)
• All relevant diagnostic reports (pathology, cardiology, neurology)

For travel/personal accident:

• Medical reports from treating physicians
• Police reports, incident reports, or other evidence of the covered event
• Receipts and documentation of claimed expenses

Step 4: File a Formal Complaint with Tokio Marine

Tokio Marine Life Insurance Singapore:

• Phone: 6336 0161
• Online: tokiomarine.com/sg/contact
• Email: sg.lifeins@tokiomarine.com
• Post: 20 McCallum Street, #06-01 Tokio Marine Centre, Singapore 069046

Tokio Marine Insurance Singapore (General):

• Phone: 6221 8611
• Email: sg.genins@tokiomarine.com

Clearly state this is a formal complaint against the claim denial. Include your policy number, claim number, appeal letter, and all supporting documentation.

Step 5: Escalate to LIA or GIA

For life/CI disputes: Contact the LIA Singapore (lia.org.sg) for Claims Conciliation Panel referral.

For general insurance disputes: Contact the General Insurance Association (GIA) Singapore (gia.org.sg) for guidance and possible mediation referral.

Step 6: File with FIDREC

If internal complaints and LIA/GIA assistance do not resolve the dispute:

• File a FIDREC complaint at fidrec.com.sg
• Filing fee: S$50 (refundable if successful)
• Deadline: Within 6 months of Tokio Marine's final response

Tokio Marine-Specific Tips

TM Shield pre-authorisation process: Submit pre-authorisation requests at least 2 working days before planned admission. Use the Tokio Marine online portal or call the 24-hour pre-authorisation line. Retain the approval reference number.

Panel hospitals and specialists: Tokio Marine's panel list is available on their website. Verify your specialist's panel status before proceeding with treatment to ensure the best coverage level.

Critical illness second opinion: If your CI claim is denied because Tokio Marine disputes the diagnosis meeting their definition, request an independent second medical opinion from a senior consultant in the relevant specialty. This opinion, specifically addressing Tokio Marine's policy definition, can be decisive.

Agent assistance: If you purchased your policy through a Tokio Marine agent, involve your agent in the dispute process. Agents often have internal escalation channels that can resolve issues faster.

Japanese corporate ethos: Tokio Marine prides itself on its reputation for reliability and trust. Framing your complaint in terms of whether their decision aligns with their corporate values (in addition to the factual and legal arguments) can sometimes be effective.

Conclusion

Tokio Marine is a reputable insurer with a long track record in Singapore, but claim denials still occur — particularly ISP pre-authorisation disputes and critical illness definition disputes. If Tokio Marine has denied your claim, file a formal complaint, gather comprehensive medical evidence, engage the LIA or GIA where relevant, and escalate to FIDREC if needed. Use ClaimBack at claimback.app to generate a professional appeal letter for your Tokio Marine Singapore insurance dispute.

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