66% of Malaysians say understanding claims and benefits is their top information need. Yet too many agents sell a policy and disappear — leaving you to figure out claims alone. Here's what you need to know and how we do things differently.
How to Claim: Step by Step
Medical Card Claims
01.Get admitted to a panel hospital — present your card at admission.
02.The hospital verifies your coverage and Guarantee Letter (GL) with the insurer.
03.For cashless admission: insurer pays the hospital directly. You pay only the excess/co-payment if applicable.
04.For reimbursement: keep all original receipts, discharge summary, and itemised bill. Submit to your insurer within 30 days.
05.Your agent should guide you through this — including which hospital to go to and what pre-admission steps to take.
Critical Illness Claims
01.Get diagnosed by a registered medical specialist. The diagnosis must match the policy's definition of the illness.
02.Notify your insurer in writing as soon as possible after diagnosis.
03.Submit claim form, specialist report, medical records, and investigation results.
04.The insurer assesses against the policy wording. This is where having an agent who knows the process matters.
05.Once approved, the lump sum is paid directly to you — use it for treatment, income replacement, or whatever you need.
Life Insurance Claims
01.The nominee or next-of-kin files the claim — not the policyholder.
02.Submit: original policy document, death certificate, claimant's IC, claim form.
03.For accidental death: also include police report and post-mortem report.
04.Insurers typically process within 14-30 days of receiving complete documents.
05.Pro tip: make sure your nominee knows about the policy. Many claims go unclaimed because families don't know the policy exists.
Personal Accident Claims
01.Seek medical attention immediately and keep all records.
02.Report the accident to your insurer within the timeframe specified in your policy (typically 30 days).
03.Submit: claim form, medical report, police report (if applicable), and receipts.
04.PA claims can cover medical expenses, temporary disablement (weekly income), permanent disablement (lump sum), and accidental death.
If You Can't Remember Your Medical Card Number
•Most Malaysian private hospitals can look up your medical insurance using your MyKad (IC number) — even without the physical card. Bring your IC and the hospital's admission or insurance counter will verify coverage on the spot.
•Prudential's Hospital Alliance Services (HAS) portal lets the hospital verify your policy directly from your MyKad, MyKid, Birth Certificate, or Passport — see Prudential's Medical Card Services FAQ.
•If your hospital can't find the policy on file, call your insurer's medical claims hotline (see Appendix below) with your IC number ready — they can usually trace the policy from there.
•As a last resort, your agent should have your policy number on file and can confirm it within minutes on WhatsApp.
Vehicle Accident Claims in Malaysia — Step by Step
If you're in a vehicle accident in Malaysia, what you do in the first hour determines whether your claim succeeds. This applies whether the accident is your fault, the other party's fault, or both. Below is the standard procedure under Malaysian law and standard motor-insurer practice.
01.Stop and check for injuries. Call 999 for medical assistance (MERS 999 / ambulance) and police if anyone is hurt.
02.Move to a safe spot. If vehicles are driveable, move them off the main road; turn on hazard lights; place a warning triangle.
03.Document the scene. Photograph: vehicle damage from multiple angles, license plates, road conditions, landmarks, position of vehicles before they're moved.
04.Exchange information with the other driver(s). Get: full name, address, phone number, NRIC (IC) number, driving license number, vehicle registration number, insurer name and policy number. Don't admit fault at the scene — let the authorities and insurers decide.
05.File a police report within 24 hours. This is mandatory under Section 52(2) of the Road Transport Act 1987. Penalties for non-reporting can reach RM2,000 fine or 6 months' imprisonment. You can file at any police station, or for non-emergency cases use the PDRM e-Reporting portal at ereporting.rmp.gov.my. Get a certified copy for your insurer.
06.Call your motor insurer within 24 hours — ideally the same day. Most insurers have a dedicated claims hotline. Delays beyond 7 days can risk claim rejection.
07.Use authorised towing and panel workshops only. Insurers may void claims if you use unauthorised tow trucks or non-panel workshops. If your car cannot be driven, ask your insurer which towing provider to call — don't arrange your own.
08.Post-accident inspection (if required). For vehicles with structural damage or airbag deployment, your insurer will usually require a PUSPAKOM inspection before repairs begin.
09.Don't make private settlements without a police report. Even a small cash settlement without a police report leaves you exposed to later claims — and insurance fraud allegations can follow undocumented payments.
10.Follow up until settlement. Your insurer will appoint a loss adjuster, assess the damage, and either authorise panel-workshop repairs or pay out (depending on your policy type — Own Damage, Knock-for-Knock, or Third-Party).
If you have a Great Eastern medical card or Personal Accident policy with the Roadside Assistance Programme benefit (eligible policies only — check your policy document), the 24-hour hotline is +603 4813 3519 for towing, minor roadside repair (covered up to RM300 per incident), car replacement referral, and hotel arrangement. Services like rental car and hotel accommodation are arranged but borne by the policyholder. Source: Great Eastern Roadside Assistance Programme FAQ.
Why Claims Get Denied
Most claim denials are avoidable. The most common reasons:
-Non-disclosure — you didn't tell the insurer about a pre-existing condition when you applied.
-Policy exclusion — the specific condition or treatment isn't covered (check your policy wording).
-Waiting period — most policies have a 30-90 day waiting period for certain conditions.
-Incomplete documentation — missing reports, forms, or receipts.
-Lapsed policy — premiums weren't paid and the policy is no longer active.
-Claim filed late — exceeded the notification deadline in your policy.
What Your Agent Should Do During a Claim
✓Respond to your WhatsApp or call within 24 hours — not "I'll get back to you next week."
✓Walk you through which hospital to go to and what to say at admission.
✓Help you complete the claim forms correctly — one missing field can delay a claim by weeks.
✓Follow up with the insurer on your behalf when processing is slow.
✓Explain the outcome clearly — if a claim is partially approved, tell you exactly why and what your options are.
Our Promise
We don't consider a policy sold until you've successfully claimed on it. When you need us, we answer. We guide you through every step of the claims process — from admission to payout. Because the moment you need to claim is not the moment to discover your agent has disappeared.
Appendix — Medical Claims Hotlines (Top Insurers in Malaysia)
If you don't have your agent on WhatsApp, these are the medical claims and customer-care lines for the major insurers operating in Malaysia. Keep them somewhere accessible before you actually need them. Numbers verified against each insurer's official website as of September 2026.
Insurer
Hotline
Source
Great Eastern Life Assurance (Malaysia) Berhad — Customer Care
This list is informational only. Coverage, products, and service levels vary by insurer and policy. Always check your own policy document for the hotline printed on your medical card. The information here was accurate as of September 2026 and is subject to change.
The claims process outlined above is a general guide based on common Malaysian insurance practices. Specific procedures, timelines, and requirements vary by insurer and policy type. Always refer to your policy contract for the binding terms and conditions. Great Eastern Life Assurance (Malaysia) Berhad's claims process applies to policies underwritten by them.
Need help with a claim or want an agent who won't disappear? WhatsApp us.