The Grievance Mechanism Committee (GMC), a multi-stakeholder platform established to address systemic issues in medical claims, has been revived with the backing of the Ministry of Health (MOH) and Bank Negara Malaysia (BNM), according to a joint press release dated 14 November.
The committee brings together medical professionals, private hospitals, insurers and takaful operators, and held its first meeting on 10 November. It is represented by the Malaysian Medical Association (MMA), the Association of Private Hospitals Malaysia (APHM), the Life Insurance Association of Malaysia (LIAM), Persatuan Insurans Am Malaysia (PIAM) and the Malaysian Takaful Association (MTA), with MOH and BNM officials participating as observers.
The GMC aims to serve as a structured consultative channel to “advise and recommend solutions to common industry issues”, supporting greater transparency and fairness in medical claims management.
Members have agreed to jointly develop standardised and transparent claims protocols to provide clarity on treatment costs eligible for claims under medical and health policies, reduce processing delays and minimise disputes.
The committee will also identify systemic challenges, maintain a complaints database and provide general guidance on resolving differences between stakeholders. However, it clarified that it does not adjudicate individual disputes or impose punitive actions.
As an immediate task, the GMC will prioritise claims protocols targeting common pain points faced by patients and the industry.
In the announcement, MMA President Datuk Dr R Thirunavukarasu said the revival supports “open, constructive dialogue” between the healthcare and insurance industry. “This collaboration is crucial in ensuring that patient welfare remains the top priority while improving mutual understanding and trust across the healthcare ecosystem,” he added.
Mark O’Dell, Chief Executive Officer of LIAM, meanwhile, noted that the renewed platform provides an opportunity to develop “practical, transparent and sustainable solutions” that improve clarity and fairness in medical coverage.
The committee will meet regularly to advance protocol development and maintain ongoing dialogue among stakeholders.
The revival comes amid mounting pressure on Malaysia’s medical and health insurance sector, with PIAM recently warning that medical inflation is outpacing premium growth and driving higher claims costs.
