The following is a case study published in OFS Annual report:
Mansor and his family travelled abroad and were required to take the COVID-19 test before boarding their return flight to Malaysia. Unfortunately, they tested positive and had to reschedule their return flights. This incurred additional expenses for self-quarantine in their hotel. The insurer paid for the COVID-19 tests, medical expenses, and flight tickets.
However, the insurer repudiated claims for the additional hotel stay during the quarantine because this policy does not cover those costs.
Mansor purchased this policy with the “PandemicAdd-on benefit”. Based on the policy terms, there is no coverage for quarantine hotel expenses.
However, before buying this policy, Mansor asked the agent whether the hotel’s quarantine cost would be covered, and the agent replied in the affirmative.
Mansor submitted WhatsApp screenshots which revealed that the agent had given inaccurate information regarding the coverage for quarantine at a hotel. The agent responded that an additional premium was required for the quarantine hotel’s coverage, influencing Mansor’s decision to purchase the benefit. On the contrary, there is no coverage for the expenses of quarantine hotels based on the policy terms.
The misleading advice by the insurance agent led Mansor to believe that their quarantine stay was covered. The case manager highlighted to the insurer the principal-agency relationship, and the insurer agreed to settle the claim.