Yes, there are circumstances where a claim will be denied. For example, if the individual is diagnosed with cancer during the waiting period (the first 60 days after the certificate takes effect), the cancer claim would not be admissible. For a detailed list of exclusions, please refer to here.
Exclusion for HLM Takaful FiT CI
Critical Illness Benefit
(a) Pre-Existing Illness;
(b) The signs or symptoms of the Covered diseases are manifested prior to or:
i. |
within sixty (60) days from the commencement date or any reinstatement date of the certificate, whichever is the latest in respect of: |
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• Cancer – of specified severity and does not cover very early cancer |
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• Coronary Artery By-Pass Surgery |
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• Heart Attack – of specified severity |
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• Serious Coronary Artery Disease |
ii. |
within thirty (30) days from the commencement date or any reinstatement date of the certificate, whichever is the latest for all other covered diseases not set out in item (i) above. |
(c) Other than the first incidence of the covered disease;
(d) The covered disease where in Our sole and absolute opinion, was caused directly or indirectly by the existence of Acquired Immune Deficiency Syndrome (AIDS) or by the presence of any Human Immuno-deficiency Virus (HIV) infection. We reserve the right to require the Person Covered to undergo a blood test to detect the presence of any HIV infection as a condition precedent before accepting any claim. For the purpose of this certificate,
i. |
the definition of AIDS shall be that used by the World Health Organization in 1987, or any subsequent revision by the World Health Organization of that definition; and |
ii. |
infection shall be deemed to have occurred where blood or other relevant test(s) indicate, in Our sole and absolute opinion, either the presence of any HIV or antibodies to such virus; |
(e) Any covered disease was diagnosed, whether directly or indirectly, due to a congenital defect or disease, which was manifested or was diagnosed before the Person Covered attained seventeen (17) years of age;
(f) Any covered disease caused by a self-inflicted injury, while sane or insane;
(g) Any covered disease resulting directly from alcohol or drug abuse;
(h) Death of the Person Covered within thirty (30) days following the date of diagnosis of any of the covered diseases; or
(i) Person Covered who himself/herself is a Professional Sports Person.