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Two reasons why insurers don't pay out claims and how to avoid them

Jun 06 2018 21:50
Allison Jeftha

Insurance is not a grudge purchase, it's an absolute necessity. It is only when a claim event happens that we truly understand and realise this. This is according to South African life insurer and pan-African financial services company Liberty Holdings [JSE:LBH].

Life and health insurance is vital as it helps to make a financial burden lighter following a death, critical illness or disability, which can prevent you from earning your normal income.

It is for this reason that it is crucial to ensure that your insurance policy is valid, so that your claim will be paid as expected.

"When you consider that Liberty paid out R4.46bn in 2017, the need for long-term insurance cover becomes clear.

"This is money which our clients and their families need to manage their finances through these difficult times," said head of risk product development at Liberty Henk Meintjes.

Last year Liberty paid out R4.46bn in claims, of which 10.2% were not paid as a result of non-disclosure and claims not meeting requirements.

When looking at all claims Liberty received in 2017, the following facts emerge: 

  • 8.6% were for conditions that did not meet claims requirements; and
  • 1.6% of claims were declined due to non-disclosure.

Here's why your claim may not be paid, and how to prevent it:

Non-disclosure

Non-disclosure is when important medical, financial, lifestyle or occupational questions are answered incorrectly or where important information is omitted when cover is first bought, explains Meintjes.

"It ranges from deliberate fraud to innocent omissions where certain information is simply forgotten."

How to avoid it:

Fin24 previously reported that full details must be given to the insurance company at all times. It amounts to dishonesty if you fail to disclose all information or misrepresent facts. Also be aware of any spelling or administrative errors.

Failure to do so will result in cover being declined or offered on different terms, including medical loadings, exclusions or limits on the sum assured. (Medical loading is the amount charged by the health insurance company on your renewal premium when you make claims in your policy.)

Not meeting claim requirements

Unfortunately, not all claims submitted to insurers are valid. Ensure that you meet all the necessary requirements pertaining to the claim payout form. Also make sure before you submit a claim that your monthly premiums are up to date. If this is not the case, your claim may be denied.

How to avoid it:

Make sure you stay up to date on your insurer’s requirements, and the implications of not meeting them.

If you have a problem making payments, contact your insurer well in advance to make alternative arrangements.

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money  |  insurance
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