Pre-existing condition clause in disability benefit– time limit on conditions excluded - onus on ins ...
Topics & Cases Archive
CR402 – Compensation – poor service – putting complainant to unnecessary effort
Background The deceased had a policy which provided cover in the event of accidental hospitalizat ...
CR401 – Repudiation of a dread disease claim – non-disclosure of material fact
Background The complainant applied for life cover to the insurer in July 2007. During August 201 ...
CR400 – Interpretation – activities of daily living cover
Interpretation – activities of daily living cover – payable only if full time caregiver is required ...
CR399 – Poor service – fairness – compensation
Background The complainant advised that he transferred a large sum of money to the insurer on a ...
CR398 – Mistake by insurer – beneficiary nomination changed
Mistake by insurer – beneficiary nomination changed – nomination change not properly effected accord ...
CR397 – Suicide exclusion – insurer failed to discharge onus to prove
Discussion The deceased passed away on 02 September 2016. The death certificate reflected the c ...
CR396 – Lapsing – SMS notification- is it in line with section 52 of the Long-term Insurance Act?
Background The insurer and the deceased entered into a policy in terms of which the insured was ...
CR395 – Lapsing – Failure to regard the policy as lapsed prejudicing the complainant’s right to reinstate the policy on favourable terms
Background The complainant took out a funeral plan covering the deceased as a parent ...
CR393 – Guardianship/Payments to minor
Guardianship/Payments to minor – insurer did not comply with own guideline – question regarding true ...
CR392 – Non-disclosure matter re-opened; death occurred 18 years ago
A. Background The policy commenced on 1 January 1998 covering the life of Ms T. She passed away ...
CR391 – Alleged misrepresentation of allocation of duties
A. Background: When Mr V, a self-employed builder, with three labour assistants, applie ...
CR390 Pre-existing condition exclusion / causation
CR390 Pre-existing condition exclusion / causation Exclusion clause – whether claim directly ...
CR389 Compulsory life annuity; commutation of monthly income payments
CR389 Compulsory life annuity; commutation of monthly income payments Compulsory life annuity ...
CR388 Retrenchment/ interpretation/ contra proferentum
CR388 Retrenchment/ interpretation/ contra proferentum Policy excluding any retrenchment clai ...
CR387 Prescription
CR387 Prescription Insurer mistakenly paying a cancer benefit in 2009 at a higher level than ...
CR386 Termination of contract/ retrenchment claim
CR386 Termination of contract/ retrenchment claim Termination of long-standing contract/retre ...
CR385 Exclusion of psychiatric disorders; constitutional rights infringed?
CR385 Exclusion of psychiatric disorders; constitutional rights infringed? Background: 1. ...
CR384 Delay in payment; interest; in duplum rule
CR384 Delay in payment; interest; in duplum rule Background: 1. The policy commenced on 1 ...
CR383 Disability claim – mineworker – hearing loss
CR383 Disability claim – mineworker - hearing loss Group scheme claim lodged in 2017 - insure ...
CR382 Mistake, lapsing, reliance, reinstatement
CR382 Mistake, lapsing, reliance, reinstatement Lapsed policy – insurer informing policyholde ...
CR381 Loss of income claim – Covid19 – is a TERS/UIF payment considered “income” in terms of the policy definition
CR381 Loss of income claim – Covid19 – is a TERS/UIF payment considered “income” in terms of the ...
CR380 Policy Exclusion: death due to participation in criminal act
CR380 Policy Exclusion: death due to participation in criminal act Accident - Deceased hit by ...
CR58 Cession of insurance policy as security for a debt to a bank
CR58 Cession of insurance policy as security for a debt to a bank – bank redeemed debt - – insur ...
CR34 Interpretation – loan protection insurance
CR34 Interpretation - loan protection insurance – retrenchment cover – interpretation of term “r ...
CR26 Funeral Insurance – dubious claims
CR26 Funeral Insurance - dubious claims.The complainant, who was also the policyholder and the prem ...
CR18 Death claim rejected due to insurer’s reliance on pre-existing exclusion clause
CR18 Background The deceased's credit life policy commenced on 6 June 2002. He died on 2 Augu ...
Deduction of penalty
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