PETALING JAYA: The Grievance Mechanism Committee (GMC), a platform bringing together medical professionals, hospitals, insurers and takaful operators and regulators to address systemic claims challenges, has been reactivated with the support of Ministry of Health (MoH) and Bank Negara Malaysia (BNM).
This marks a renewed commitment by the healthcare and insurance/takaful sectors to strengthen collaboration, transparency and fairness in medical claims management.
The GMC aims to provide a structured, consultative channel for dialogue, to advise and recommend solutions to common industry issues, and to promote mutual trust and respect between the medical profession and the insurance industry.
The reactivated GMC held its first meeting on Nov 10. It was attended by five member organisations – Malaysian Medical Association (MMA), Association of Private Hospitals Malaysia (APHM), Life Insurance Association of Malaysia (LIAM), Persatuan Insurans Am Malaysia (PIAM) and Malaysian Takaful Association (MTA). Officials from MoH and BNM joined as observers.
At the meeting, the GMC committed to improving communication among all members and agreed to cooperate on developing transparent claims protocols for the management of claims that are payable under medical and health insurance/takaful products.
The claims protocols will be co-developed by specialists and payers and are intended to provide clearer guidance to medical practitioners, insurance and takaful operators (ITO) and hospitals on treatment costs that can be claimed under medical insurance and takaful policies. This in turn aims to reduce delays in the claims process and minimise disputes.
The GMC serves as a consultative body, tasked with identifying systemic challenges, keeping a database of complaints, and recommending solutions for adoption by its members. While it does not adjudicate individual disputes or impose punitive action, it reviews complaints received through medical professional bodies and industry associations with the objective of resolving differences by bridging knowledge gaps between the medical and insurance sectors and providing broad guidance consistent with the fair treatment of policyholders and ethical management of patients.
As an immediate priority, the GMC will prioritise claims protocols to deal with common claims pain points, forming the foundation for the GMC’s continued work towards practical best practices.
MMA president Datuk Dr R Thirunavukarasu, said: “We welcome the revival of the GMC and value the open, constructive dialogue it fosters between the medical profession and the insurance sector. This collaboration is crucial in ensuring that patient welfare remains the top priority while improving mutual understanding and trust across the healthcare ecosystem.”
APHM president Datuk Dr Kuljit Singh said, “The GMC provides an important platform for private hospitals and insurers to work together in a spirit of partnership and transparency. By aligning practices and addressing issues collectively, we can enhance efficiency, strengthen trust, and ultimately deliver better outcomes for patients.”
Speaking on behalf of members representing the ITO industry, Mark O’Dell, CEO of LIAM, said: “We are pleased to re-engage in this renewed, regulatory endorsed platform that allows insurers, takaful operators and medical professionals to work alongside regulators to find practical, transparent and sustainable solutions. Our focus is on protecting policyholders, improving claims clarity, and ensuring access to fair, efficient, and timely medical coverage.
“By working closely with doctors, hospitals and regulators, we can foster greater trust between the industry and the medical community, while safeguarding the interests of our policyholders and participants, and delivering on our promise of timely protection and commitment to fairness and mutual assistance.”
The GMC will meet regularly to advance its work on the claim’s protocols, address recurring claims challenges and maintain ongoing dialogue among all parties.
