CR225

Late submission

Background

The life insured died on 24 October 2005. The policy provided for a notification period of six months. A death claim was lodged on 3 March 2006, well within the submission period. The complainant submitted the required documentation with the claim. The only difficulty was that the copy of the death certificate, although clearly genuine, was so badly copied that it was illegible. The insurer, as it was entitled to do, requested an improved copy which was thereupon submitted in May 2006 (some weeks after the six month period had expired). The insurer then declined the claim on the basis that the legible certificate was submitted beyond the notification period.

The insurer was invited, but declined, to review its decision. Consequently, the matter was discussed in a meeting of adjudicators.

Discussion

The meeting considered the circumstances surrounding the claim as well as the insurer’s decision to decline it. The meeting was of the view that the insurer’s insistence that the corrected copy should also have been delivered within the prescribed period could not be supported. Not only did the contract contain no provision to that effect but the result was patently unfair.

The meeting expressed its displeasure at the manner in which the insurer handled the matter. It was difficult to escape the conclusion that it was a deliberate attempt to avoid paying out a legitimate claim.

Result

The meeting resolved that the claim should be paid. Furthermore, the meeting mandated the Ombudsman to address a letter to the Chief Executive Officer of the insurer concerned to convey its sentiments. A prompt and positive response was received thereafter, and the claim was paid.

TS
MAY 2007