The life insured had taken out a policy with a direct life insurer. The policy has a clause which states:
"If the life assured will, during the contract period, be outside of the borders of South Africa for longer than 60 (sixty) continuous days, we will require written notification of this prior to leaving South Africa to determine if we are able to continue the cover or terms thereof. Failure to inform us of such changes will result in the benefit being reassessed at claims stage in line with the relevant underwriting practice at that time. This may result in a claim being reduced or rejected and premiums forfeited."
The life insured left South Africa on 20 May 2010 and flew to Belgrade, Serbia for business purposes. He left Serbia for a holiday in Bali on 8 June and then returned to Serbia on 13 July intending to return to South Africa the first week of August 2010. The life assured died from a heart attack on 29 July 2010 in Serbia.
At first the insurer declined the claim on the basis that the life insured had not notified them that he would be outside South Africa for more than 60 days. The complainant, the insured’s wife, produced documents that reflected that the life insured had sent emails to the insurer notifying it of his intended absence from South Africa. The insurer denied receiving these emails (and provided system reports as evidence of this) and added that in any event there had been no confirmation to the life insured that cover would be extended in terms of the insurer’s underwriting practice.
The insurer also stated that in terms of its underwriting practice it would not have granted cover for the period that the life insured was in Serbia.
We upheld the insurer’s decision on the following grounds:
- Even if we accepted that the life insured had sent the emails to the insurer, he was not entitled to assume, without confirmation, that the insurer would provide cover during his stay abroad.
- In terms of its underwriting practice and its re-insurer’s practice the insurer did not provide cover for lives insured while they were in Serbia, when the abovementioned provision in the policy operates.