Health Insurance Claim Disputes Filed with MAS or FIDReC and Proportion Resolved in Favour of Policyholders

Sir, I refer the Member to the Monetary Authority of Singapore's (MAS') response to Mr Liang Eng Hwa and Mr Ng Shi Xuan for the Parliament Sitting on 4 November 2025.

Over the same three-year period of between 2022 and 2024, the Financial Industry Disputes Resolution Centre (FIDReC) completed an average of 246 annual mediation and adjudication claims related to disputes on insurance claim liability and amounts awarded. Of these, an average of 95 were health insurance claims. Independent assessors ruled in favour of the policyholders in 4% of the health insurance claims.

Thank you, Mr Speaker. I thank the Minister of State for the reply. Given the very low percentage of adjudicated claims being in favour of the policyholders, has the Minister of State assessed why this is the case? For example, is this due to clearer policy terms or perhaps there are structural disadvantages that policyholders face? Because there has been ground feedback from healthcare providers that policyholders face delays or rejections, even at the pre-authorisation stage or even post-treatment, due to retrospective interpretations of policy terms.

So, I would like to ask if MAS has safeguards in place to ensure that insurance companies adjudicate claims transparently, consistently and do not disadvantage policyholders, especially when there are clear clinical indications for treatment.

Sir, I thank Dr Hamid Razak for his questions regarding the safeguards for consumers where they potentially face so-called unreasonable rejections of claims and pre-authorisation.

The onus is on the insurers themselves to demonstrate that the non-disclosure of the health condition to a question asked in the application form is material to the underwriting outcome before they reject a claim for non-disclosure. And both MOH and MAS expect insurers to process these claims fairly, according to the policy terms. MAS will take action against insurers who fail to do so.

Consumers who, nonetheless, believe that their claims have been unfairly rejected, should, first, contact their insurers who are required to handle these complaints independently, effectively and promptly. If a satisfactory resolution cannot be reached, consumers may file for mediation and adjudication at FIDReC, which offers independent, partial and low-cost dispute resolution services.

But I thought it is also important to put that 4% into context and take a look at the overall denominator. If you look at the numbers in perspective, every year, insurers naturally process and pay out claims in large numbers, large volumes. The numbers of disputes and complaints that eventually end up in FIDReC or MAS, respectively, represent less than 0.01% of all insurance claims. So, if we think about this one out of every 10,000 claims end up as disputes or complaints, which FIDReC or MAS then addresses. But the vast majority, 9,999 of these 10,000 are processed and they are paid out.

This indicates that for the vast majority of cases, the process works and most people settle their claims without needing any third-party help. But when a case does go into adjudication, as in that 4%, it is usually because it is complex or difficult. Think about our Meet-the-People Session cases, when they come to us, it is already quite complex.

But these cases fall into two broad categories, which I thought is important to share with the Member. First is on policy terms. If the adjudicator found that the insurer followed the specific terms and exclusions of the policy, that is one case; and even as the policyholder may disagree with the result. Second is when there is an event of a non-disclosure. And this happens when the policyholder leaves out certain medical history that he thought was not important at the start but actually was.

For example, to make it concrete, a person might not mention that he or she has a stomach condition when they apply for an insurance policy, and that if they later try to claim for a stomach-related issue, the adjudicator may rule that the insurer was right to exclude it because the information should have been shared from the start.

But while there is only a small number, which the Member mentioned, 4%, that result in an award for policyholder, I wanted to share with the House that there is a silver lining. Because we are seeing that the total number of cases needing adjudication has been dropping over the last few years. This indicates that maybe the insurers and consumers are getting better at speaking to one another and resolving issues early through mediation and negotiation, rather than the alternative of letting things escalate.

But behind every statistic is a person. And when a claim is rejected, it can be distressing. So, we have designed our system to address these issues to ensure fairness.

First, MAS expects insurers to pay legitimate claims promptly. If an insurer falls short of this, MAS will step in and can require them to review the earlier decision or to pay back the consumer. Second, if you cannot agree with your insurer, FIDReC is there. It is independent, impartial and low cost. And over 85% of their cases are resolved through mediation or adjudication, and it remains a very effective channel for Singaporeans.