CR390 Pre-existing condition exclusion / causation
CR390 Pre-existing condition exclusion / causation Exclusion clause – whether claim directly or indirectly attributable to pre-existing condition – test for legal causation The exclusion clause in the policy read: In the case of disability and severe illness benefits, [the insurer] will not pay a claim during the first twelve months of the life assured […]
Read MoreComplaints Data 2021
Figures published for the period from 1 January to 31 December 2021. View Complaints Data 2021 here.
Read More2021 Second Reminders
Where an insurer has more than five second reminders per year, the number of reminders is published with the complaints data. The names of the insurers and the number of the second reminders sent to them during 2021 appear alongside. More than five second reminders 2021 3Sixty Life 200 Nestlife 18 Safrican 13 Hollard Life […]
Read MoreFinal Determinations 2021
Case 48 Non-disclosure at application stage – insurer has onus of proof – onus not discharged Background: 1. Mr N’s Liberty policy provided, inter alia, disability benefits and critical illness benefits. 2. A claim was submitted for hypertension with chronic kidney disease under the critical illness benefits. 3. The claim was declined by Liberty because […]
Read MoreCR389 Compulsory life annuity; commutation of monthly income payments
CR389 Compulsory life annuity; commutation of monthly income payments Compulsory life annuity – beneficiaries seeking lump sum payment instead of monthly income payments after death of annuitant before guarantee date – insurer stating that policy could not be commuted – whether there was any legislative or contractual impediment to payment of lump sum Background 1. […]
Read MoreCR388 Retrenchment/ interpretation/ contra proferentum
CR388 Retrenchment/ interpretation/ contra proferentum Policy excluding any retrenchment claim “where the retrenchment was announced within the first 6 months” – on the specific facts of this case, employer letter giving notice of proposed restructure and inviting consultation not an announcement of insured’s retrenchment – his actual retrenchment announced after expiry of the six month […]
Read MoreCR387 Prescription
CR387 Prescription Insurer mistakenly paying a cancer benefit in 2009 at a higher level than it should have been paid – insurer realising mistake when a claim for progression of cancer lodged in 2020 – insurer seeking to set off the new claim against the amount overpaid in 2009 – debt prescribed. Background: 1. The […]
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