Wednesday, 22 May 2019

Check your insurance policy to avoid claims disappointment

Durban – The Association for Savings and Investment South Africa (Asisa) said the case highlighted the need for life insurance applicants to openly disclose all vital information. This includes medical history, state of health, family history and lifestyle.

Asisa medical underwriting standing committee convener Dr Maritha van der Walt said: “Problems at claim stage can be completely avoided with full disclosure of all the required information when you take out a policy.”

She said having all the facts at their disposal, the life insurer’s underwriters can determine the exact risk relevant to each applicant, which sees premiums being adjusted for different risk categories. She said that if your medical condition or lifestyle choices were considered a material risk, the life insurer may offer the cover on different terms such as a higher premium or exclusions on disability cover or critical illness benefits. In a small percentage of cases, the applications are declined.

She said while South African insurers paid 99.3% of all claims against fully underwritten life policies last year (this does not include partially underwritten policies), half of the claims that were declined were because of non-disclosure.

Van der Walt advised on the following:

* If you have taken out a life insurance policy and suspect you may not have disclosed something that may be relevant, go back to your financial adviser or directly to your insurer and tell them you didn’t realise (the condition) had to be disclosed. The insurer will re-underwrite the policy from day one and you can negotiate to get the best terms.

* If you develop a disease/condition eg diabetes, heart problems, cancer after the policy has been put in place, it is a new condition after inception of the policy and you are under no obligation to tell them. But if you have a lifestyle change such as taking up smoking, cycling or mountain climbing after having taken out a life insurance policy, you must advise your insurer.

* Some policies seem to require a medical and some don’t. Factors such as age, past medical history, lifestyle and how much cover you need are all taken into account.

* Answer all questions truthfully and you will not have to worry about the claim stage.

Independent On Saturday Source:

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