Contract Comprehension: Prudent Takaful Claim Decision

Takaful Dinamik Berhad (TDB) is one of the leading takaful companies in Malaysia. Yusof bin Ahmad purchased one of its products, the investment-linked takaful plan, five years ago. He had dutifully paid all his contributions (i.e., premium) since the policy was enforced. Sadly, Yusof was diagnosed with a Primary Progressive Multiple Sclerosis disease. After the diagnosis, he submitted a claim to TDB under the critical illness benefit. His claim was nonetheless rejected on the basis of not meeting the duration of the illness, nor demonstrating the symptoms of the illness as specified in the policy. The decision to reject the claim was made by Borhan, the claim manager of TDB, after a thorough consideration of the case. After the rejection, Yusof then submitted an appeal through the Central Bank of Malaysia (or Bank Negara Malaysia, BNM). In ensuring fair treatment to all policyholders, BNM requested TDB to promptly re-examine Yusof’s claim. This case presents the challenges of understanding the coverage, the concepts, and the provisions of takaful contract in making a claim decision. The case ends with Borhan pondering on how best to resolve the dispute.