• Funeral Insurance – proof of claim
The complainant, Mr A, was a member of the F funeral scheme, underwritten by company X. The scheme provided for cover for family members. Mr A alleged that he was the biological father of a minor child, SB and that Ms B, to whom he was not married, was SB’s mother. He instituted a claim on the policy against company X which claim was declined for lack of proof of his relationship to SB.
According to the insurer Mrs C, also a member of the F funeral scheme, alleged that she was the mother of SB and lodged a claim on her policy in respect of his death.
The policy provided: “Upon the death of any person insured under this policy, notice of the claim together with all the necessary supporting documentation required by company X must be sent to it within 6 months of the date of death. No claim, where documentation is submitted after 6 months of the date of death will be paid.”
The insurer stated that: “two people cannot have one person under the same medical aid. We need legal documents from one of the claimants to prove that he or she is the biological or adoptive parents of the child.”
So, too, no person can have two biological mothers.
Both claimants, Mr A and Mrs C, submitted affidavits stating that each of them was the biological parent of the child without conceding that the other one was the other parent.
Company X, not unreasonably, insisted on some proof, beyond the mere say – so of the two claimants, of proof of parentage since even such minimal proof as a “birth registration document indicating the parents’ names” could not be furnished.
We were eventually compelled to agree with company X “that there is reasonable doubt that one of the claims is fraudulent” and, in the absence of satisfactory proof as to which one it was, the complainant’s claim could not be upheld.