Here are some of the reasons why insurers are likely to reject a claim and how you can avoid having your claim denied.

Can an insurer deny my claim?

You have just found out that a loved one has passed on. Furthermore, they had taken out life cover, listing you as a beneficiary. The first thing to do is to notify the insurer to get the claim process underway. According to ASISA, South African insurers have paid a total of R63.7 billion in claims to date.

However, just because they had a policy in place does not mean that the claim will automatically be paid out. An insurer will first have to check that the information is correct and up to date. If not, they could deny the claim. 

What can cause my claim to be denied?

One of the common things that can cause your claim to be rejected is non-disclosure. Non-disclosure means that the policyholder has not given their insurer all the important information concerning their occupation, health, possession, or medical history. Some people even do this unintentionally which can end up costing them. It’s vital to update your insurer on any changes that occur in your life related to these to ensure that your policy is up to date. Some of the other reasons are:

• Not meeting the claim requirements. Your insurer will require documents that you will need to submit based on whether the death was accidental or natural. Not having documents such as a fully completed claim form, a certified copy of the death certificate, completed DHA-1663 form, a certified copy of the beneficiaries I.D’s, 3 months bank statement for all beneficiaries, and police report in case of an unnatural death may lead to your claim not being paid.
• Premiums not being up to date. If the premiums have not been kept up to date or cancelled before the policy holder has passed on, it can cause the insurer to deny the claim.
• Committed suicide within the waiting period. Most policies have a waiting period which means a period of time needs to pass on before you are actually covered. When it comes to life insurance, this is usually 24 months. If the policy holder passes on with suicide as a cause of death during this time frame, the claim will not be paid out.
• Not disclosing changes in your health or lifestyle that could impact your health. For example, you may have taken out a policy while you were still healthy, but later found out that you have cancer or diabetes. Perhaps you started off as a non-smoker but started smoking later which will essentially affect your health.
• Participating in any of the exclusions that have been listed. All policies come with a list of exclusions that an insurer will not cover a person for. Participation in any of these can cause the claim to be rejected.

It is possible to contest a claim, but it is vital to check that your loved one has not contravened the terms and conditions of the policy. Not only will this make it a smoother process, but it will also help you move on with peace of mind.