THE Federation of Malaysian Consumers Associations (FOMCA) has criticised the delays in settling medical dispute claims by the Ombudsman for Financial Services (OFS).

Its president Datuk Marimuthu Nadason said the long wait erodes the trust and confidence of financial services consumers in OFS’s consumer dispute resolution system.

“The OFS was set up to provide fair treatment to consumers. Not all complaints from the financial services sector are accepted by OFS, hence no opportunity for the consumer to be heard,” he told The Health newspaper.

Marimuthu said the most serious complaint is the long waiting time for a financial service complaint to be resolved. According to the OFS 2022 report, more than 36% of cases were pending for over six months.

He was responding to an article in the March-April issue of The Health on the timeline the OFS took in settling medical claims and financial disputes. Following the article, feedback from readers indicated that it could take more than a year for a dispute to be settled.

Formerly known as the Financial Mediation Bureau, the OFS is supposed to provide independent, fair, efficient and effective dispute resolution to financial consumers. Its service is free for all financial consumers (individuals and SMEs).

Justice delayed is justice denied

According to Marimuthu, alternative dispute resolution system (ADR) mechanisms like the OFS exist to speed up complaint resolution.

“Speed and ease in resolving complaints are crucial in any ADR system. Hence, FOMCA seriously views the maxim ‘justice delayed is justice denied’ as it impinges on consumer rights,” stressed the 62-year-old advocate and leader in the field of consumerism and social development.

“The OFS is currently being supported by the financial services sector through subscription to have adequate financial and human resources to resolve all kinds of complex disputes of medical and hospitalisation claims.

“Therefore, it must improve its efficiency in resolving disputes fairly and be an effective ADR mechanism for complainants/policyholders.”

In response, OFS CEO Marina Baharuddin provided a breakdown of the resolution timelines for medical and hospitalisation claims in 2023. She said of the 62 cases handled, 55 were efficiently resolved within less than six months.

Meanwhile, an additional seven cases were settled within a reasonable timeframe of six to nine months. None of the cases exceeded a year.

However, out of the 111 medical and hospitalisation cases received in 2023, 12 remain unresolved as of May 13, 2024. The disputed amount for these claims in 2023 ranged from RM136 to RM202,709, with an average claim of RM21,085.

Conflict-of-interest concerns

On the possible conflict of interest arising from financial service providers (FSPs) sitting on the OFS board, Marimuthu said the OFS should receive direct financial resources from the Finance Ministry to ensure financial independence rather than to rely on financing from the financial services industry.

“Moreover, the government should ensure that the independent directors’ representation on the OFS board should not be those from the financial services sector.”

Marina assured its board composition included independent board members and representatives from the banking and insurance sectors. The majority of the board comprised independent directors, thus ensuring a balance in the decision-making process.

Notwithstanding this, representatives from the banking and insurance sectors are appointed by the respective industry associations such as the Association of Banks in Malaysia (ABM) and the Life Insurance Association of Malaysia (LIAM).

This allocation is outlined in Article 13(d) of OFS’ Articles of Association. Currently, the board consists of five independent directors and four non-independent directors from these sectors.

Its non-executive independent directors are Tan Sri Dr Foong Cheng Yuen (Chairman), Tan Sri Zaleha Zahari, Sujatha Sekhar Naik, Datuk Dr Paul Selvaraj and Shahariah Othman. Its non-executive non-independent directors are Tan Sri Dr Tay Ah Lek (Deputy Chairman), Datin Veronica Selvanayagy, Anthony Fook Weng Lee and Ratna Sha’erah Kamaludin.

Tay is currently Public Bank Bhd’s managing director and CEO while Veronica is currently the General Counsel of AIA Malaysia for AIA Bhd, AIA Public Takaful Bhd, AIA General Bhd, AIA Health Services and AIA Pension Asset Management Sdn Bhd.

Meanwhile Fook is currently the General Insurance Association of Malaysia’s (PIAM) and the Malaysian Insurance Institute’s (MII) chairman while Ratna Sha’erah is currently the executive director of the Association of Islamic Banking and Financial Institutions Malaysia (AIBIM).

Towards this end, Marina pointed out that while FSP representatives sit on the board, their role is primarily advisory with no involvement in the dispute resolution process. This structure safeguards the impartiality and integrity of the OFS, thus mitigating concerns surrounding undue influence or bias.

She further asserted that the presence of industry representatives on the board is crucial in gaining insights into systemic issues within the banking and insurance industries.

These board members provide valuable feedback to enhance industry practices and offer a perspective from within the sector. However, the board does not directly handle disputes.

The OFS maintains that safeguards are in place to prevent conflict of interest, transparency and accountability. - July 1, 2024

https://focusmalaysia.my/fomcas-marimuthu-slams-ombudsman-for-financial-services-for-claims-delays/