CR184 Funeral Insurance – definition of dependent relative – brother-in-law.

See too: CR, Funeral Insurance,

CR184
Funeral Insurance – definition of dependent relative – brother-in-law.

Background

The complainant complained to us that the insurer refused to pay out on a funeral policy which he had taken out through a bank. His brother-in-law had died. He stated: “My late brother-in-law was traditionally married and had two wives and both wives respected one another.” He further stated that there had been “lots of phoning” to the insurer and “lots of confusion” about what claim documents were required and that he was told that there had been a misrepresentation of the facts.

We forwarded the complaint to the insurer but received no response within the allotted time span. As is our normal practice we then made a preliminary ruling on the documentation on file and, based thereon, we advised the insurer that the policy which covered the deceased should be paid. In addition, because the complainant had alleged that he suffered inconvenience as a result of the insurer’s conduct, we made a compensatory award of R1500.

It was only then that the insurer responded by pointing out that no death certificate had been submitted in respect of the claim. They also referred us to the summary statement which contained the following definition :

“Other Dependant Relatives:
A relative of the member, under the age of 65 at Commencement date, who satisfies one of the following criteria:
a) ………
b) ………
c) Any other relative who is fully dependent on the member and the relationship can be adequately substantiated.”

Discussion

The insurer stated that tapes of telephone conversations in its possession showed that the deceased had left the complainant’s sister six years previously and that he was living with another woman at the time of his death. The insurer noted that it would require proof of the relationship (a marriage certificate/customary union certificate) and details of the extent to which the brother-in-law was dependent on the complainant.

We wrote to the complainant and asked him whether he could provide us with the required documentation. The complainant responded that all the required claim documents had earlier been faxed to the insurer via the branch of the bank. He furthermore pointed out that the deceased had two wives: the junior wife with whom the deceased had been living in the city at the time of his death, while his more senior wife had stayed behind in the Eastern Cape. He also pointed out that the marriage to the complainant’s sister was a traditional lobola marriage, that no marriage certificate was available but that an affidavit in respect of the traditional marriage had been sent to the insurer together with the other claim documents.

Result

The insurer then did an about-turn and advised us, without furnishing any reasons, that they had reviewed the claim and had decided to admit it. The claim was paid and the case was closed.

JP
November 2006

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