Medical Insurance Claim Case Summary – Duty To Disclose (June 2025)
ROSALIND GOH LEE LING v. GREAT EASTERN LIFE ASSURANCE (MALAYSIA) BERHAD [2025] CLJU 1547 – Shah Alam High Court
Background
Rosalind Goh had medical insurance with Prudential but in 2018 bought a new policy from Great Eastern Life through an insurance agent. She claimed she told the agent about her past health problems – bronchitis and acid reflux (GERD) – from 2017.
In the policy application form, however, she answered “No” to questions about whether she had ever had these conditions.
In 2020, less than two years after taking the policy, she made two medical claims. Great Eastern investigated and found hospital records from 2017 showing treatment and hospitalisation for bronchitis and GERD. The company said this was a material fact she should have disclosed. Her claims were rejected and her policy was cancelled from the start, with her premiums refunded.
Rosalind sued Great Eastern and the agents, saying she had told them about her medical history and any failure to include it in the form was the agents’ fault. She also claimed the agent persuaded her to give up her Prudential policy.
The High Court Judge’s Findings (Summarized)
- Duty to Tell the Truth in Insurance Applications
- Insurance contracts are based on utmost good faith – you must tell the insurer all important health facts honestly and completely.
- Under the Financial Services Act 2013, even if you think a condition is not serious, if the insurer asks a clear question about it, it must be disclosed.
- Why the Plaintiff Lost
- The Court found she did not tell the agent about her bronchitis and GERD.
- She had four chances to mention these conditions – when applying, when giving documents in 2020, when correcting the doctor’s report, and when naming her doctors – but didn’t.
- She only produced the medical reports in Court.
- The judge believed she deliberately hid this information, which amounted to fraudulent non-disclosure.
- Blaming the Agent Didn’t Work
- The law says the duty to disclose health facts is on the person buying the insurance, not just the agent.
- She also had a 15-day “free look” period to check the policy and correct any errors but didn’t use it.
- Other Claims Rejected
- No proof that the agent promised better benefits or told her to cancel her Prudential policy early.
- In fact, she cancelled her Prudential policy more than a year later, not within 120 days as she claimed.
Judgment
Based on the above, the Shah Alam High Court dismissed Rosalind’s case against all defendants with costs of RM50,000 to Great Eastern and RM50,000 to the two agents.
Important Legal Points To Protect Yourself:-
Non-disclosure may lead to your policy being cancelled and claims refused, even years later if fraud is proven. Always be completely honest when answering health questions in an insurance application – even if you think the illness is minor or over. If you’ve been hospitalised or diagnosed, disclose it. The insurer will decide if it matters, not you. Review your policy documents immediately. Use the free look period to correct mistakes.
Consult Us For More Information!
🌐 Call us: 017-6965 966 (Call/Whatsapp) / 013-4400128 (Whatsapp)
📩 Email Us: nick@jykolaw.com
Or fill in the contact form CLICK HERE
Disclaimer: The above proposition is subject to actual facts and circumstances and shall never be referred as the actual law without seeking legal advice. Consult us for more information!