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 in September 2016. The insurer declined the claim relying on the suicide exclusion clause which reads as follows:
- During the first 2 (two) years from the Commencement Date, the Insurer will not be liable to pay a benefit if any claim arises directly or indirectly from or is traceable to self-inflicted injuries, suicide or attempted suicide.
- The insurer relied on the police statement which gave a short description of the circumstances of death as follows:
- The deceased allegedly drank stameta to clean his stomach and later taken to hospital where he passed on.
- The insurer also relied on the postmortem report which concluded that the cause of death was consistent with organophosphate pesticide ingestion/poisoning.
- Stameta is a body healing liquid which is very popular amongst the Black Community. Stameta helps to strengthen the immune system and relieve various conditions such as digestive problems, constipation, lower back and joint pains and fatigue.
- We pointed out to the insurer that there was no indication that the deceased took anything else other than the stameta. According to the police statement there was no possibility that the deceased committed suicide. It was possible that the deceased was poisoned prior to drinking stameta but there was no evidence that he committed suicide.
- The insurer’s attempts to obtain an inquest report to determine the cause of death failed. For this reason, they decided to review their decision.
Result
The benefit was paid accordingly.
