Low FMOS Uptake For Health Insurance Disputes In 2025

KUALA LUMPUR, Feb 9 — Health insurance disputes made up only 3.4 per cent of complaints received by the Financial Market Ombudsman Service (FMOS) in 2025, with about three-quarters of those cases resolved through mediation and adjudication.

Finance Minister Anwar Ibrahim, in a written Dewan Rakyat reply on January 22, said FMOS received 112 complaints related to health insurance products out of 3,253 total complaints recorded since it began operations on January 17, 2025. 

Of the health insurance complaints, 83 cases (74 per cent) were resolved, with estimated avoided legal costs of RM1.245 million if the disputes had gone to court.

This means roughly one in four health insurance complaints filed were not resolved.

FMOS only began operations in January 2025, and complaint volumes may change as awareness of the ombudsman channel increases.

Across all product categories, FMOS resolved 2,268 of 3,253 disputes, or about 70 per cent.

“The FMOS functions as a dispute resolution centre for financial consumers and investors nationwide,” Anwar said in response to Selayang MP William Leong Jee Keen. 

“The establishment of FMOS strengthens operational synergy among financial and investment dispute resolution schemes while ensuring the resolution process is fairer, easier, smoother, and free for financial consumers and investors.

“Based on the latest data, since beginning operations on January 17, 2025, FMOS has received 3,253 complaints, of which 2,268 disputes have been successfully resolved through mediation and adjudication,” he said. 

“Complaints received are generally resolved on a case-by-case basis.”

Under rules set by Bank Negara Malaysia (BNM), financial institutions must inform consumers of their right to refer disputes to FMOS after issuing a final decision on a complaint, before pursuing court action.

“BNM has set that financial institutions must inform consumers of their right to submit complaints to the alternative dispute resolution channel, namely the FMOS, before taking legal action in court,” Anwar said.

He added that the majority of FMOS board members are independent of management and financial industry ties, and that its adjudicators are also independent.

CodeBlue previously reported recurring issues in health insurance claims handling, including delays and denials, while Bayan Baru MP Sim Tze Tzin has said many policyholders are unaware of available dispute resolution channels.