Ombudsman ruling for an over-age student on a funeral policy.

How does the Ombudsman Rule on an over-age student claim problem that a father brought to his attention?

  • The Ombudsman deals with each case individually.
  • A lot is going to depend on what the policy stipulations are.
  • If you have children going off to tertiary education, you need to check your plan.
  • Adult children may need to be covered separately, even though dependent.
  • Most policies have a cut-off date in terms of age for dependents to be covered.

 

Let’s look at how the Ombudsman might handle the issue of an adult child who is a full-time student.

Some background to the Over-age Student claim Problem

Over-age Student claim ProblemThe claim, in this case, was declined because the child was deemed as being over-age in terms of the provisions of the policy.

This is where it really pays to know the terms of your policy. In this case, the policyholder’s son was a student at the Durban University of Technology. He was studying towards a qualification in Mechanical Engineering.

The child was about to register for the 2012 academic year when he died in a car crash. He died on the 6th January. The Durban University of Technology confirmed that registration for the 2012 year was only to open on the 18th of January.

The policy covered dependent children up to the age of twenty-two. Insurers consider children older than this to be adults.  The company makes allowances for full-time students attending an educational institution that is recognized. Full-time students are covered until they reach the age of twenty-six.

The father lodged a claim against the insurer. He submitted the required documentation along with proof of the child’s academic record from the start of his studies.

Claim Declined

The insurer declined the claim. He did not qualify for cover as he had not yet registered for the 2012 academic year.  According to the exact terms of the policy, this was true.

The Ombudsman asked that the claim be reconsidered as the child would most likely have registered when registrations opened. His record as a full-time student was used as proof of this. The Ombudsman further noted that the failure to register was as a result of circumstances beyond the child’s control.

The Durban University of Technology gave them information about registration. His academic record excluded him from the continuation of his course. The university would not have admitted him.

As a result of this, the Ombudsman found in favour of the insurer.

And the Moral of the Story is…

It must have been a hard lesson for the father to learn but it should serve as a warning to all of us. If you take out funeral cover, or any other insurance for that matter, you must know the terms. Check what the policy covers. Find out what might void cover and where you might need to supplement cover.

This is one situation where simply going for the cheapest option could end up costing you.

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