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CR380 Policy Exclusion: death due to participation in criminal act

CR380 Policy Exclusion: death due to participation in criminal act Accident – Deceased hit by a train while allegedly walking on a railway line – Reliance by insurer on exclusion for death as a result of active participation in criminal act – Reference to Section 12(i)(h) of Schedule 1 of the Legal Succession to the […]

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CR321 Exceptions and exclusions

CR321 Exceptions and exclusions Retrenchment benefit – cover not applicable to independent or fixed term contractors – complainant employed on a temporary basis. 1. The complainant, who was employed on a temporary basis, was retrenched and lodged a claim for a retrenchment benefit with the insurer. 2. The clause applicable to the retrenchment benefit provided: […]

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CR308 Exceptions, Exclusions and Waiting Periods

Exceptions, Exclusions and Waiting Periods CR308 Exclusion c lause –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. 1. In this case the complaint arose out of a life policy also covering hospital expenses. The policy commenced […]

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CR308 CAUSATION-Exclusion clause

CAUSATION CR308 Exclusion clause – requiring that the claim event must be “as a consequence of” the pre-existing condition – must therefore be the proximate cause – meaning of. 1. In this case the complaint arose out of a life policy also covering hospital expenses. The policy commenced on 1 May 2009, and it contained […]

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CR300 Exceptions, Exclusions and Waiting Periods- Exclusion clause – causation.

Exceptions, Exclusions and Waiting Periods CR300 Exclusion clause – causation. BACKGROUND The deceased, a 30-year old male, was granted cover under a policy the inception date of which was 14 July 2008. At the same time the policy was ceded to a financial institution to cover his credit agreement with them. He died on 26 […]

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CR299 Exceptions, Exclusions and Waiting Periods -Exclusion clause – causation.

Exceptions, Exclusions and Waiting Periods CR299 Exclusion clause – causation. BACKGROUND The deceased, a 34-year old male, was granted cover under a policy the inception date of which was 4 September 2006. The policy was at the same time ceded to a financial institution to cover his housing loan. He died on 8 August 2007 […]

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CR261 Exclusion clause – “any back condition” excluded

CR261 Exclusion clause – “any back condition” excluded – complainant sustaining a neck injury – neck injury not excluded. BACKGROUND The complainant took out a life policy that also provided for an instalment protection benefit in respect of his mortgage bond. The commencement date of the policy was 1 September 2005, and for the instalment […]

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CR260 Exception – exclusion clause – event arising from pregnancy – interpretation.

CR260 Exception – exclusion clause – event arising from pregnancy – interpretation. BACKGROUND In a health policy the complainant was covered for hospitalisation costs. One of the exclusions stipulated that: “No Benefit will be payable if an insured Event is a result of, by, for or from …abortion, pregnancy or any condition arising therefrom.” When […]

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CR249 Exclusion clause – is the insurer entitled to rely on the exclusion clause?

CR249 Exclusion clause – is the insurer entitled to rely on the exclusion clause? Background Mr N had two policies with the insurer. They were ceded to the bank to provide cover for his housing loan. On 14 January 2007 he died in a motor vehicle accident. The insurer declined both claims, relying on the […]

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CR245 Exceptions and Exclusions Benefits excluded for hospitalisation

CR245 Exceptions and Exclusions Benefits excluded for hospitalisation – mental disease or disorder – an interpretation of the policy wording Complaint In denying liability the insurance company relied upon an exclusion in the policy for mental diseases or disorders. The policyholder denied mental illness. Background The policy provided cash benefits relating to periods spent in […]

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