CR366
Funeral benefit

Claim declined on the basis that the parties were divorced prior to the conclusion of the contract.

Background

1. The complainant took out a funeral plan covering her husband, two children and two extended family members. The policy commenced in July 1999.

2. The deceased passed away on 16 March 2015 as a result of unnatural causes. When the complainant instituted a claim for the payment of the death benefit, the insurer declined to pay the benefit on the basis that the parties were divorced prior to the commencement of the policy.

3. In doing so, the insurer relied on a final order of divorce issued by the then Supreme Court of Bophuthatswana on 24 April 1997 and an affidavit deposed to by the deceased on 11 October 2006 confirming that the parties were indeed divorced. The complainant disputed that they were divorced and submitted a letter from the National Prosecuting Authority of South Africa (“NPA”) dated 14 March 2005 dealing with a fraud case that was lodged against the deceased before he died. The aforesaid letter reads as follows:

“We read your representation and the relevant police docket. The following was observed.

(a) The divorce document appears to be falsified.

(b) The accused alleges that he had instituted divorce proceedings and was given the divorce document by his attorney who has since passed away.

(c) Further investigation by the police confirmed that the accused’s divorce file at the deceased attorney was destroyed.”

4. The NPA concluded that there was proof that the decree of divorce was invalid, meaning that the marriage between the deceased and the complainant still subsisted. However, they declined to prosecute because they did not have evidence to prove that the deceased did not obtain the divorce order from his attorney. Despite this information, the insurer maintained that it was not legally obliged to accept liability to pay the claim.

5. The complainant also submitted a divorce order that was issued by the same court in the same year containing the same case number, but with different dates and different parties.

Discussion

6. On receipt of the second court order, we pointed out to the insurer that it clearly showed that something was amiss because we have never heard two separate cases from the same court, bearing the same case number, but reflecting different parties. We requested the insurer to clarify from the court whether the court order relevant in this matter was valid or not.

Result

7. The insurer came back indicating that they were prepared to pay the complainant’s claim on a without prejudice basis and the benefit was paid accordingly. Our file was closed.

NS

March 2016