CR335
Funeral Insurance

Funeral policy – Insurer declining on basis of child not being registered as a full-time student at date of death and therefore over age in terms of the policy provisions

Background

1. The policy-holder had a funeral policy which covered his son, the relevant policy rule stipulating that –

“2.6 Membership will cease:
…
(b) for dependent children, when they attain the age of 22, or 26 years if they are still registered as full-time students / scholars at a recognised educational institution…”

2. The son had been registered at the Durban University of Technology since 2007 studying mechanical engineering.

3. He passed away on 6 January 2012 as a result of a motor vehicle accident, shortly prior to registering for the 2012 academic year.

4. A death claim was lodged with the insurer. Documents submitted included a record of the deceased’s academic record dating back to 2007.

5. The Durban University of Technology confirmed that registration for the 2012 academic year opened on 18 January 2012.

6. We requested the insurer to consider the claim on the basis that the probabilities favoured the late son’s registration in that he had been a regular full-time student since 2007 and that his death had occurred prior to the opening of registration.

7. The insurer maintained that he had not registered prior to the date of death and therefore did not qualify for cover in terms of the policy.

8. Further enquiries were made with the Durban University of Technology, where it was confirmed that the deceased would have been excluded from registration as he did not meet the academic criteria required to continue his studies.

9. On the available information, the complaint could not be upheld. The insurer had grounds to reject the claim.

GB
March 2013