Socso uses a combination of technology and manual verification to identify possible fraudulent claims before approval is granted.
PETALING JAYA: The Social Security Organisation (Socso) implements a strict vetting process before approving benefit claims to prevent fraudulent applications, Human Resources Minister Datuk Seri R. Ramanan told the Dewan Rakyat.
He said claims are not automatically approved, as each application is assessed step by step based on supporting documents and information submitted by claimants.
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“It is a very rigid process. There are assessment teams and units to ensure falsification does not occur. It is a step-by-step vetting process. Approval is not given automatically,” he said.
Ramanan was responding to a supplementary question from Dr Abd Ghani Ahmad (PN–Jerlun), who asked whether false claims had been made against Socso and how effective technologies such as artificial intelligence (AI) were in detecting such cases.
He said Socso uses a combination of technology and manual verification to identify possible fraudulent claims before approval is granted.
Earlier, Datuk Mohd Isam Mohd Isa (BN–Tampin) raised the case of Nur Syafiq Azwan in Tampin, alleging weaknesses in the claims process, including misalignment between Socso forms and hospital procedures, system update delays of up to six weeks, and non-coverage of surgery costs despite severe workplace injury conditions.
He also said doctors had confirmed that the injury was work-related, and questioned whether the ministry conducted regular audits of claims management and whether a fast-track mechanism could be introduced to improve coordination between hospitals, employers and Socso.
In response, Ramanan said he would instruct Socso to review the details of the Tampin case.
On performance audits, he said Socso conducts benefit management audits every six months, while its 2025 customer satisfaction survey recorded a 95% satisfaction rate.
He added that coordination between hospitals and Socso is being improved, particularly for complex cases involving serious workplace injuries and medical devices such as implants.
Ramanan said Socso recorded 96% compliance with its customer charter for claims and benefit payments in 2025.
He said processing times vary depending on the type of benefit, with funeral benefits and temporary disability benefits processed within two days, while permanent disability, invalidity pensions, survivors’ pensions and dependants’ benefits are processed within three days.
“For the period from January to December 2025, Socso’s customer charter performance for claims and benefit payments averaged 96%,” he said.
