Pre-existing condition clause in disability benefit– time limit on conditions excluded – onus on insurer to prove the pre-existing medical condition existed within the time frame and its causal link

Background The deceased had a policy which provided cover in the event of accidental hospitalization. The deceased had been hospitalized for an extended period from 16 June 2016 to 18

Background The complainant applied for life cover to the insurer in July 2007. During August 2013 she added additional benefits, inter alia a dread disease benefit to the policy. In

Interpretation – activities of daily living cover – payable only if full time caregiver is required – meaning of ‘full time’ BACKGROUND The complainant, a housewife, submitted a claim under

Background The complainant advised that he transferred a large sum of money to the insurer on a Thursday. He visited a branch of the insurer’s on the same day and

Mistake by insurer – beneficiary nomination changed – nomination change not properly effected according to insurer The complainant was one of the two policyholders and beneficiary of the policy applied

Discussion The deceased passed away on 02 September 2016. The death certificate reflected the cause of death as “Under Investigation”. The complainant, who is the deceased’s wife, submitted a claim

Background The insurer and the deceased entered into a policy in terms of which the insured was covered for a funeral benefit of R30 000. The policy commenced on 1