When a Critical Illness Claim Gets Denied: What Every Policyholder Should Learn from the AIA Brain Tumour Case
October 2025 – A recent story has sparked intense discussion among insurance policyholders in Singapore and Malaysia. Frankie Yee, a 57-year-old man diagnosed with a benign brain tumour, underwent surgery in late 2024 after doctors advised him that the growth could soon affect his memory and become life-threatening.
When he filed a S$100,000 critical illness claim with his insurer, AIA, he was stunned to learn that his claim was rejected. The company’s reason? According to the definition applied to his decade-old policy, his tumour was “not life-threatening” at the time of surgery.
You can read the original source of the story at:
https://mothership.sg/2025/10/man-with-brain-tumour-denied-why/
The Heart of the Issue: What Defines a “Critical Illness”?
Most policyholders assume that if a condition is serious enough to require brain surgery, it automatically qualifies as “critical.” But insurance is governed not by perception — rather, by definitions written in policy contracts.
In Singapore (and similarly in Malaysia), the Life Insurance Association (LIA) standardises the list of 37 critical illnesses. Each illness comes with a formal definition that insurers must follow.
As of 2025, the LIA defines Benign Brain Tumour as a non-malignant growth within the brain that must either be surgically removed or cause permanent neurological damage. Nowhere in this definition is the term “life-threatening” included.
However, when Frankie Yee purchased his plan ten years ago, the older definition did require the condition to be life-threatening — and it’s that original wording that applied to his claim. Definitions evolve with medical science, but the terms locked in at purchase remain binding throughout the policy’s life.
The Hidden Challenge: Who Reads 70 Pages of Policy Wording?
This case highlights a recurring problem in the insurance industry — information asymmetry between agents, insurers, and clients.
Former insurance agents often admit that product summaries can exceed 50 pages, filled with technical language even professionals find difficult to interpret. Few customers read them word-for-word before signing, trusting instead that “critical illness” means what it sounds like.
Yet, small differences in phrasing, such as the presence or absence of the word “life-threatening,” can decide whether a claim is approved or denied.
The agent’s role, while crucial, is primarily to represent the insurer. Unless an agent voluntarily goes the extra mile, there’s no guarantee the client will fully understand the limitations buried in the fine print.
What Policyholders Can Learn
Frankie Yee’s case is not isolated — many Malaysians face similar frustrations when their critical illness or medical card claims are rejected on technical grounds. Here’s how consumers can better protect themselves:
-
Read and keep your policy documents.
Always retain the original policy wording. The version valid at purchase governs your rights, even if definitions change later. -
Ask direct questions before buying.
Don’t just ask, “Does this plan cover brain tumours?” Ask, “Under what specific conditions would a brain tumour be covered?” -
Clarify medical terms.
Request written clarification of technical phrases like life-threatening, permanent neurological deficit, or invasive surgery. -
Check claim definitions every few years.
Compare your policy’s language with the latest industry standard (LIA or Bank Negara Malaysia guidelines). This helps identify outdated coverage. -
Consider second opinions for diagnosis and reporting.
The insurer’s decision depends heavily on medical reports. If a claim is rejected, a fresh neurological or radiological assessment may help your appeal. -
Seek mediation if needed.
In Singapore, disputes go through FIDReC; in Malaysia, through BNM’s BNMLINK and the Ombudsman for Financial Services. These channels can reopen cases where definitions were applied unfairly.
The Need for Empathy and Clarity
Behind every denied claim is a person in pain — not just physically, but emotionally and financially. As one former agent put it, terms like “not life-threatening” may be technically correct but lack empathy toward the patient’s reality.
Insurance companies have a duty to uphold transparency, while agents and regulators must continue educating the public on how coverage actually works.
For consumers, the key is awareness: buying a critical illness plan isn’t enough; understanding it is equally vital.
Final Thoughts
Frankie Yee’s story is a sobering reminder that fine print can have life-changing consequences. Whether you’re covered by AIA, Prudential, Great Eastern, or any Malaysian insurer, make it a habit to review your critical illness policy definitions — especially those written before 2015.
Medical technology evolves, but so must financial literacy. A proactive approach today can prevent heartbreak tomorrow.
Related reading:
Learn more about medical card plans, hospitalisation coverage, and how to file an insurance claim effectively at Medicard.my.