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INSURANCE policyholders whose claims for cancer treatment are delayed or denied have legal grounds to take insurers to court, according to veteran lawyer M. Manoharan.
He emphasised that an insurance contract is a binding agreement, and insurers refusing payouts without proper justification can be challenged in court.
“Litigation is time-consuming and time is something a cancer patient cannot afford to waste. They can sue the insurer for breaching the contract, but the priority should be treating the deadly disease first,” he told The Star.
Manoharan warned that court proceedings can drag on for months or even years. “If they eventually win the case, it may be purely academic if they succumb to the illness before the judgment.
“On the other hand, if they lose, they may be slapped with additional financial losses, including legal fees for their lawyer and possibly for the insurer.”
He advised patients to focus on securing treatment and regaining their health before considering legal action, noting that the emotional and financial strain of litigation can exacerbate the stress of undergoing cancer treatment.
Drawing from his own experience, Manoharan cited a case in Seremban where a stroke patient’s claim was initially rejected due to pre-existing conditions. After months of negotiations, the insurer agreed to an out-of-court settlement.
“We need a system that is fairer, faster, and more compassionate. Insurance companies must urgently iron out these problems so as not to unnecessarily stress out patients with terminal illnesses.
“The government must intervene to ensure fairness and that policyholders are not left fighting alone for treatment they should be entitled to,” he said.
Manoharan suggested the introduction of a national health insurance scheme to provide coverage for major illnesses with affordable premiums and potential co-payments, ensuring no patient is left behind.
The Health Ministry is reportedly in discussions with Bank Negara and the Finance Ministry to address delays and denials of cancer insurance claims, while exploring ways to strengthen patient protection.
The National Cancer Society of Malaysia (NCSM) has warned that ideal treatment options for insured patients are often delayed, with insurers questioning doctors’ recommendations or downgrading procedures.
NCSM managing director Prof Dr M. Murallitharan said patients can be caught in a “quandary” when approvals are withheld or further justification is demanded before critical treatment can proceed. - November 6, 2025