What Clients Say About Working With Harmoni Counsel

Challenge

A Subang Jaya resident had her medical insurance claim declined following inpatient treatment. The insurer cited a pre-existing condition exclusion. She had disclosed all known conditions at policy inception and disputed that the treated condition qualified as pre-existing under the policy definition.

Approach

Harmoni Counsel reviewed the policy definitions carefully and found the insurer's interpretation extended the exclusion beyond its stated scope. A coverage opinion letter was prepared and an OFS complaint filed. Medical records supporting the client's position were collated and presented to the Ombudsman.

Outcome

The OFS found in the client's favour. The insurer settled the claim in full within the timeline set by the Ombudsman's decision. The client did not need to proceed to court, and the full matter was resolved within four months of initial instruction.

Challenge

A mid-sized Selangor manufacturer had grown through acquisition and was operating with an insurance programme that had not been reviewed in over three years. Coverage placed for the original entity no longer reflected the group's full asset base or operational exposure, and a recent fire at an acquired subsidiary had exposed gaps.

Approach

Harmoni Counsel conducted a risk mapping exercise across all subsidiaries, identified coverage gaps, overlapping policies, and conditions precedent being non-complied with at two sites. A risk-transfer matrix and revised broker-instruction document were prepared, incorporating takaful options for one subsidiary with Shariah compliance requirements.

Outcome

The revised programme placed via the broker-instruction document eliminated the identified gaps, consolidated two redundant policies, and structured takaful participation for the subsidiary requiring it. The engagement was completed within six weeks and the group's renewal was placed on a properly structured basis.

Challenge

A retail business owner received an insurer's final offer that represented approximately 55% of the assessed reinstatement value following storm damage. The insurer applied an average clause that the business owner believed was unjustified given the declared value at policy inception.

Approach

Harmoni Counsel reviewed the policy, the insurer's average clause calculation, and the original sum insured declaration. The review found the insurer's application of the average clause was contestable on the basis of the declared value history. A written negotiation position was prepared and submitted directly to the insurer's claims manager.

Outcome

After two rounds of written negotiation, the insurer agreed a revised settlement at 83% of the reinstatement value — materially higher than the initial offer. The client avoided OFS or court proceedings, and the matter concluded in approximately three months from instruction.