Healthcare, Insurance Industries Revive GMC To Strengthen Medical Claims Management

KUALA LUMPUR, Nov 14 (Bernama) -- The healthcare and insurance/takaful industries have reactivated the Grievance Mechanism Committee (GMC) with the support of the Health Ministry and Bank Negara Malaysia, bringing together medical professionals, hospitals, insurers, takaful operators, and regulators to address systemic claims challenges.

The GMC represents a renewed commitment by the healthcare and insurance/takaful sectors to strengthen collaboration, transparency and fairness in medical claims management, its member organisations said in a joint statement today.

The committee, which held its first meeting on Nov 10, 2025, is represented by five member organisations, namely the Malaysian Medical Association (MMA), the Association of Private Hospitals Malaysia (APHM), the Life Insurance Association of Malaysia (LIAM), the General Insurance Association of Malaysia and the Malaysian Takaful Association.

According to the statement, 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.

It serves as a consultative body, tasked with identifying systemic challenges, keeping a database of complaints, and recommending solutions for adoption by its members.

LIAM chief executive officer (CEO) Mark O’Dell said the platform focuses 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,” he said.

During the Nov 10 meeting, the GMC committed to improving communications 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, insurers and takaful operators (ITOs) 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 statement said.

MMA president Datuk Dr R. Thirunavukarasu said this collaboration among industry players is crucial in ensuring that patient welfare remains the top priority while improving mutual understanding and trust across the healthcare ecosystem.

Meanwhile, 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," he said. 

Going forward, 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, the statement said.

-- BERNAMA