Exceptions, Exclusions And Waiting Periods [NEW]

See too: Causation [NEW],

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  • pdf CR351 - Exclusions - Causation [NEW]
    Pre-existing condition exclusion clause – dispute as to proximate cause of death - whether pre-existing conditions directly or indirectly caused death, or whether death was caused by cancer which emerged after cover commenced (CR351)
  • pdf CR348 - Exceptions
    Exclusion clause – Acquired Immune Deficiency Syndrome (AIDS) or HIV infection, including all phases and consequence thereof (CR348)
  • pdf CR322-Exclusion clause [NEW]
    Exclusion clause – inserted in definition of an “accident” only – could it be interpreted to apply as a general exclusion as well?(CR322)
  • pdf CR321- Exceptions and exclusions [NEW]
    Retrenchment benefit – cover not applicable to independent or fixed term contractors - complainant employed on a temporary basis. (CR321)
  • pdf CR308 - Exclusion clause
    Causation - clause requiring that the claim event must be "as a consequence of" the pre-existing condition - must therefore be the proximate cause - meaning of.
  • pdf CR300 - Exclusion clause
  • pdf CR299 - Exclusion clause
    Exclusion clause - was the insurer entitled to rely on it? (CR299)
  • pdf CR261 - Exclusion clause
    "any back condition" excluded - complainant sustaining a neck injury - neck injury not excluded.
  • pdf CR260 - Exception
    Exception - Exclusion clause - event arising from pregnancy - interpretation (CR260)
  • pdf CR252 - Exclusion clause - suicide - onus of proof
    Exclusion clause - suicide - onus of proof - Claim repudiated on insurer's presumption of suicide, based on post-mortem and police report - onus on insurer to prove suicide exclusion applied - insufficient evidence to prove suicide on a balance of probabilities - unreasonable in circumstances to await inquest report (CR252)
  • pdf CR249 - Exclusion clause
    Exclusion clause - Is the insurer entitled to rely on the exclusion clause? (CR249)
  • pdf CR245 - Exceptions and Exclusions
    Exceptions and Exclusions - Benefits excluded for hospitalisation - mental disease or disorder - an interpretation of the policy wording (CR245)
  • pdf CR244 - Exceptions - Exclusions
    Exceptions - Exclusions - Where death results from heart disease - whether heart attack necessarily results from heart disease (CR244)
  • pdf CR243 - Exceptions and exclusions
    Exceptions and exclusions - Pre-existing medical condition, lung cancer - whether later liver cancer could be termed as pre-existing (CR243)
  • pdf CR217 - Disability claim under credit life policy
    Disability claim under credit life policy - Insurer relying on pre-existing condition exclusion clause - was claimant aware of or ought reasonably to have been aware of the pre-existing condition? (CR217)
  • pdf CR210 - Waiting period - payment - funeral policy
    Waiting period - payment - funeral policy - failure to pay premium - lapsing of policy - fresh waiting period (CR210)
  • pdf CR183 - Exclusion clause
    Exclusion clause - HIV diagnosis prior to commencement date but after application date (CR183)
  • pdf CR176 - Exclusion - causation
    Exclusion - causation - Death resulting from pre-existing condition excluded - whether death was caused by the insured's pre-existing condition or by an intervening cause (CR176)
  • pdf CR135 - Exceptions and Exclusions - suicide
    Exceptions and Exclusions - suicide - When is suicide suicide? (CR135)
  • pdf CR83 - Death claim - accidental death policy
    Death claim - accidental death policy - Whether the deceased negligently or intentionally exposed himself to danger; whether the death directly or indirectly arose from or could be traced to an action of the insured while his blood alcohol percentage was over the prescribed limit (CR83)
  • pdf CR82 - Accidental death benefit declined
    Deceased's concentration of alcohol in blood excessive - no causal link between concentration of alcohol and deceased's accidental death.
  • pdf CR81 - Uitsluiting
    Geen dekking in geval van wedrenaktiwiteite klaer ontevrede omdat hy sy betrokkenheid met wedrenne wel op aansoekdatum vermeld het.
  • pdf CR80 - Exclusion clause
    Is it applicable where circumstances surrounding cause of death unclear - onus on the insurer to prove.
  • pdf CR18 - Death claim
    Death claim - Rejected (CR18)
  • pdf CR16 - Exclusions
    Exclusions - Fishing for info (CR16)
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