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CR376 Probabilities of Accidental Death for payment of Accidental Death Benefit

CR376 Probabilities of Accidental Death for payment of Accidental Death Benefit Accidental Death Benefit – insurer accepting death as accidental on probabilities – requiring actual proof that accidental to pay benefit Background 1. The policy was a funeral policy which provided a funeral benefit of R5000 with an additional R5000 if the death was accidental. […]

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CR371 Accident Claim for accidental benefit due to bodily injury

CR371 Accident Claim for accidental benefit due to bodily injury Background: 1. The complainant had a laminectomy and fusion of vertebrae. The operation was deemed successful but in time she suffered chronic back pain and was declared permanently disabled for her own occupation by her employer. Some time after she had been boarded, she experienced […]

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CR370 Accidental Death Policy covered “accidental death”

CR370 Accidental Death Policy covered “accidental death”; was the deceased’s death accidental? The policy covered ‘accidental death’ which was defined in the policy as a “traumatic death caused solely by external, violent, unforeseeable and visible means, occurring independent of any other causes and within 14 days of such trauma proved to the satisfaction of the […]

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CR322 Exclusion clause – inserted in definition of an “accident” only

CR322 Exclusion clause – inserted in definition of an “accident” only – could it be interpreted to apply as a general exclusion as well? Background Ms F held policies that provided her with cover for hospitalization resulting from illness or accident. An accident was defined in the policy, the relevant portion stipulating that – “Accident […]

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CR170 Accident – whether an operation for cosmetic reasons

CR170 Accident – whether an operation for cosmetic reasons resulting in death qualified as an accident as defined in the policy – causation Background The insured took out a policy offering cover against accidental death. Although warned that a gastric bypass operation was a high risk operation, the insured underwent it in order to control […]

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CR83 Death claim – accidental death policy – whether the deceased negligently or intentionally exposed himself to danger

CR83 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. Background The complainant was the wife of the deceased […]

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CR82 Accidental death benefit declined – deceased’s concentration of alcohol in blood excessive

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. Background The deceased had an endowment policy which provided for payment of a benefit to the nominated beneficiary in the event of the insured passing away due to unnatural causes. […]

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