CR329

Late submission of claims

Claim delayed by police taking possession of documents for criminal investigation.

A group scheme funeral policy, of which a funeral parlour was the beneficiary, stipulated that a claim would not be payable if not submitted within 6 months of death. The main member, her partner and her minor child were covered under the policy, and all three died in a fire in their home in June 2010. Their burial was interrupted by the police who, suspecting that the main member’s partner had been involved in criminal activities, therefore took possession of the bodies and all relevant documents including the death certificates. The police investigation took longer than 6 months thereafter. Because it would be late for the purposes of the policy the funeral parlour decided not to submit a claim, but instead to recoup the burial costs from the family of the main member.

The family of the main member submitted a complaint to the office, and after intervention we were advised by the insurer that the claim would be admitted in respect of all three insured persons. Payment followed in August 2011, fourteen months after the date of deaths.

Late submissions of claims are generally not accepted by insurers under group schemes and funeral policies, especially where the claim is submitted a substantial period of out of time. It can sometimes happen, however, that timeous submission is beyond the control of the claimant. In this matter the insurer, which frankly did not claim to have been prejudiced by the delay, agreed that the circumstances justified the relaxation of the 6 month restriction.

NvC
January 2012