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CR347 Non-disclosure Complainant failing to disclose relevant medical condition

CR347 Non-disclosure Complainant failing to disclose relevant medical condition – cover granted on standard terms – complainant subsequently disclosing diagnosis in servicing alteration application – was the underwriting agent’s failure to notice the “change of health” disclosure inadequate underwriting? Background The complainant had at application stage failed to disclose that two months before applying for […]

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CR313 Non-disclosure – Claim for Disability Income Benefits

Non-disclosure CR313 Claim for Disability Income Benefits– should a consultation during 2005 have been disclosed, and was it material to the risk. BACKGROUND On 25 May 2008 the complainant applied for a policy which offered inter alia Disability Income Benefits and which commenced on 1 July 2008. During February 2010 she submitted a claim for […]

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CR306 Non-disclosure – Equity – new policy issued as replacement

Non-disclosure CR306 Equity – new policy issued as replacement – old policy cancelled – non-disclosure in application for new policy, and new policy cancelled – can claim be entertained on the replaced policy? Background 1. The complainant’s wife, Mrs P, had a policy covering death and dread disease. On 30 June 2009 she made an […]

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CR291 Non-disclosure Complainant’s refusal, after lodging his claim

CR291 Non-disclosure Complainant’s refusal, after lodging his claim, to consent to the insurer obtaining a report from the specialist who had treated him – office unable to support the complainant. BACKGROUND At all times the complainant held a life policy that also offered sickness benefits. He had previously made a claim, citing depression as the […]

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CR290 Non-disclosure Pre-existing conditions – whether insured had failed to disclose relevant information.

CR290 Non-disclosure Pre-existing conditions – whether insured had failed to disclose relevant information. BACKGROUND In June 2006 the complainant’s wife (“the deceased”) applied for and was issued with a R2 million life policy. She passed away in November 2006 as a result of SLE (lupus), an auto immune disease. In the period preceding the application […]

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CR271 Non-disclosure – bipolar mood disorder

CR271 Non-disclosure – bipolar mood disorder – dispute about whether diagnosed before inception of the policy – onus on insurer. BACKGROUND Through her employment the complainant was a policyholder in a group scheme for which she was covered inter alia for permanent disability. The policy’s inception date had been in November 1995, and it was […]

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CR270 Non-disclosure – complainant unaware of his condition

CR270 Non-disclosure – complainant unaware of his condition – his doctor having failed to inform him thereof, and having further failed to disclose it in the medical certificate accompanying the proposal form – misrepresentation was therefore by independent third party, not applicant for insurance. BACKGROUND In 2003 the complainant had signed a proposal for cover […]

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CR269 Non-disclosure – when knowledge of representative will be imputed to insurer

CR269 Non-disclosure – when knowledge of representative will be imputed to insurer – constructive knowledge –representative of insurer appointed to assist applicants for insurance in filling out proposals – thereafter to enter such information on an electronic form for assessment by underwriters – representative being told of a relevant condition but failing to enter it […]

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CR231 Non-disclosure – Policy cancelled on grounds of non-disclosure

CR231 Non-disclosure – Policy cancelled on grounds of non-disclosure- alleged re-instatement of policy after death of insured life – reinstatement abortive Background By virtue of a buy and sell agreement, the complainant took out a policy on the life of his business associate for an amount of R3m. When a disability claim was lodged under […]

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CR200 Non-disclosure –materiality – remedies

CR200 Non-disclosure –materiality – remedies – may an insurer rescind if it would have contracted in any event albeit on different terms? Background The insured took out a life policy which also provided disability cover. Some five months after the conclusion of the contract the insured sustained brain injuries in a motor vehicle accident. This […]

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