How to avoid your insurer denying your life insurance claim
Non-disclosure of an existing condition that is relevant to the claim is clear grounds for an insurer’s refusal to pay.
You can avoid your insurer denying your life insurance claim if you follow the claims process and ensure that you ae completely honest and tell your insurer the truth about everything you insure, including yourself.
South Africa’s life insurers paid out benefits amounting to a total of R578 billion in 2022 according to the Association for Savings and Investment South Africa (ASISA), included life, disability, critical illness and income protection policies claims.
Avinash Baboolal, of Hollard Life Solutions, says only a small portion of claims are declined. “The claims process is arguably one of the most crucial aspects of the policy cycle and it is the insurer’s responsibility to make sure that this process is as seamless as possible for the policyholder.”
He says it is very important for policyholders to know what their policies entail to ensure that claims are paid out on time without issues. “From the onset it is also important to be absolutely honest in your policy application. You must disclose all medical conditions at the application stage to avoid having to provide additional information at the claim stage, which could delay the process, or have the claim declined.”
Declare any medical issues upfront
It is particularly essential to declare a medical condition or symptoms of a medical condition before the policy starts.
“Furthermore, it is important to ensure that your monthly premiums are paid when due to avoid the policy lapsing. Be aware of any waiting periods before the policy is in force. It is also important to understand any policy exclusions and what other conditions form part of the policy and seek advice from your broker or insurer if you are unsure of anything regarding the policy and exclusions.”
Baboolal says claims are normally declined if these measures are not taken.
If you ensured that you follow the process and were completely honest with your insurer but your claim is still denied, you can reach out to the office of the Ombudsman for Long-term Insurance that deals mainly with repudiation disputes. It also looks into complaints about poor communication or poor service from insurers.
“Clients often raise concerns about not receiving adequate advice regarding policy requirements and conditions when their claims are denied. However, it is crucial that clients communicate these concerns up-front with their advisors and also escalate these concerns with the insurer to ensure that they are satisfied with the onboarding process.”
He says it is crucial to review your policies every year with your broker to make sure that the policy is still relevant to your needs. It is also important to update the beneficiary details and other information regularly.