CR92

Funeral policy with accident cover – deceased insured died from unnatural causes – funeral claim paid but accident cover payment withheld

Background

The insured deceased took out a funeral policy, which included accidental death benefits, in December 2002. In December 2003 the deceased died as a result of unnatural causes. According to the police report in February 2004 he had been a pedestrian and had been lying on the road surface when a motorist drove over him. The post mortem examination reflected that the deceased had died as a result of head and chest injuries ostensibly sustained when the motor vehicle drove over him. The insurer paid the funeral claim in the amount of R10 000 to the complainant but refused to pay any death benefits since it alleged that in the absence of an inquest there was insufficient information to justify the accident cover payment. The complainant approached us for assistance.

Discussion

It appeared to us that the insurer was liable to pay the accident benefit unless the policy contained an exclusion covering circumstances where the insured had exposed himself to danger i.e. lying in the road.

Result

Since the policy did not contain an exclusion as aforesaid the insurer was ordered to and paid an amount of R10 000 to the complainant.

AS
October 2005