Mothership - AIA denies S$100,000 payout to S'pore man with benign brain tumour, said condition 'not life-threatening' at time of surgery & not includ

[dambio]

this month got another insurance claim dispute too right?

https://www.straitstimes.com/singap...s-ntuc-income-for-wholly-unreasonable-conduct


no wonder my friend refuses to buy any insurance ...

Meanwhile we're made to pay compulsory on some gov schemes.

 

[hwarzoner]

lucky i dont have any insurance with AIA

 

[Laguna123]

This can only claim under early diagnosis of illness?

 

[DragonFire]

https://mothership.sg/2025/10/insurance-critical-coverage-tumour/​

AIA denies S$100,000 payout to S'pore man with benign brain tumour, said condition 'not life-threatening' at time of surgery​

An AIA policyholder submitted a Straits Times forum letter calling for greater regulatory scrutiny of how insurance companies define “life-threatening” conditions.

This was after his claim for critical illness coverage, which he bought "several years ago", was rejected, despite undergoing surgery for a benign brain tumour.

Diagnosed with brain tumour, had surgery​

Frankie Yee Kok Wah was diagnosed with the tumour in 2018, his Oct. 20 forum letter read.

As the tumour was initially small and asymptomatic, his doctor advised against surgery, opting instead for annual MRI surveillance to monitor changes in the tumour's size.

However, in November 2024, a scan revealed significant tumour growth.

Concerned that it could begin affecting his neurological functions and overall quality of life, his neurosurgeon strongly recommended surgical removal.

Yee proceeded with the operation.

Hospitalisation and critical illness claims rejected​

When he submitted his hospitalisation and critical illness claims following the procedure, both were denied.

AIA’s stated reason for rejecting the S$100,000 critical illness claim was apparently that the tumour was "not life-threatening" at the time of surgery.

Yee said this interpretation was deeply problematic and asked if a policyholder must "wait until his condition becomes fatal" before a claim can be accepted:

But sir. They are an insurance company and not an entity sworn to protect the Hippocratic Oath.

No responsible (to it's shareholders) insurance company would pay out on a policy covering ‘life-threatening’ conditions if the conditions were manifestly not life-threatening at the time. The strict definition of life-threatening refers to something with immediate potential to cause death.

Disability or reduced quality of life is NOT life-threatening.

Ergo, the condition must threaten to be fatal for the coverage to be invoked. If you are merely going to go blind, or be confined to a wheelchair for life, go make a claim under your policy that covers that.

 

[kuti-kuti]

Thats why i believe only in saving for ownself med needs unless kana forced to do so that type just settle for the min required by law

 

[paperplane1943]

Actually why never get pre authorisation for claims before operation?

 

[klim668]

Insurance agent earned his money, doctor also earned his money. Guy kena double penatrated both sides...

 

[llx384]

Surely hospitalization is covered by AIA. Should always get AIA panel doctor. They'll submit pre auth for you.

 

[bochup84]

Benign brain tumour is not even staged but graded. I suspect ECI also cannot claim. Any agent can confirm?

This kind is surgery, claim shield plan, take HL, then go back to work.

 

[Taloona]

Actually why never get pre authorisation for claims before operation?

That one is for hospitalisation. They will pay part of the total bill if it is a co-payment and total bill if it is a rider. I think for this man's case, he is claiming under "Critical illness" and not for the hospital bill. If successful, the amount is extra pocket money for him.

My sister could claim for Critical illness after she has had a heart attack and went for a bypass surgery.

 

[mastermember]

Got

Think most critical illness only cover advance stages. Aia i suppose covered the hospitalisation

Got early CI.. Unless that also got clause unfair to consumers

 

[David Lai]

emergencies and life threatening aside, next time before getting the surgery done, talk to the insurance company to find out if its claimable first, then decide what to do next…

 

[ShinnAsuka]

thats why read black and white yourself

agents paint u a pretty picture where u can claim most conditions and in poor health, u can profit and cover gaogao

nope

Massive pages of tncs, not everyone will be going through those docs,

I'm not sure if it is explicitly indicated about what is fatal and non fatal, if it is not, then this is where the grey area is. Plus more often than not, one would have signed the policies way earlier than when things happened.

Ultimately, insurance is just selling a lottery on your fears to feed their pockets and the mdrt agent pockets. Ultimately still a company. More successful claims, p&l drops, financial statement looks bad and investors, shareholders unhappy.

Not saying one shouldn't buy, but do consider the risk of getting rejected when making claims. I doubt the agents even know 100% what they are selling, because they don't decide if u can successfully claim or not.

 

[0nePunchm@n]

emergencies and life threatening aside, next time before getting the surgery done, talk to the insurance company to find out if its claimable first, then decide what to do next…

but all surgery in hospital are covered by shield plan right?

 

[jack-320]

Next time only uplorry can claim

Then next time become so stringent that even after uplorry also cannot claim

what a good business model, cash flow keep coming in and never go out

 

[kebinu]

Yup. Contractual agreements. Be mindful of what u sign for.

don’t be resistant when insurance agent wants to meet for review. Yes it’s true that they want your money. But it’s also through that some policies will become obsolete in coverage.

CI payout maybe ok. but I read shield plan also reject? wtf?

 

[Ender]

The plan is critical illness plan. Usually life threatening. Not the usual hospitalisation plan which I think he should be able to claim that.

 

[Chunchunmaru]

You look at it logically, there's a brain tumour, we don't know whether it'll turn cancerous, anyone in his right mind would want go operate on it because it is a clear sign that something is not right. Benign always has a chance of turning malignant.

The only thing really holding the patient back is the risk involved, not so much the cost.

And here AIA is saying don't worry, only your carpet is on fire, we can't pay you for the cost of fighting this fire. Wait until your entire living room is on fire, with your dog trapped inside, then you can call the fire engine and we will pay for their services ok?

Their agents go around gloating about how much they've made off people like you and me with their showy lifestyles and fancy cars, but when it comes time to pay up, the companies they represent stonewall.

Insurance firms make huge money of us because so many never have a need to claim and the premiums are greedily gobbled up. A case like this crops up and they deny payment.

Big G needs to regulate these guys.

 

[trento]

but all surgery in hospital are covered by shield plan right?

Yes but issue here is AIA didn't cover the CI part

 

[havetheveryfun]

That one is for hospitalisation. They will pay part of the total bill if it is a co-payment and total bill if it is a rider. I think for this man's case, he is claiming under "Critical illness" and not for the hospital bill. If successful, the amount is extra pocket money for him.

My sister could claim for Critical illness after she has had a heart attack and went for a bypass surgery.

the article says he submitted both hospitalisation and CI but both were denied

"When he submitted his hospitalisation and critical illness claims following the procedure, both were denied."