Do You Give Up if Your Funeral Claim is Declined?
Funeral claim declined and you want to find a solution? Read on…
For most South Africans, the company that we take our policy through has the final say in whether or not our claim is going to be paid. If they decline the policy, that leaves us in something of a rough spot – we need the money to bury our loved one but how do we win the argument?
And this where most people stop. They think that the only way for this to be resolved is to get lawyers involved and that is a very expensive alternative. What most people don’t realize, though, is that they are able to take the case to mediation with the Ombudsman for Long-Term Insurance.
The Ombudsman’s ruling is binding on the insurer so don’t lose hope yet. Let’s look at an example of a case and how it would work.
The insurance company refused to pay out because the couple had gotten a divorce before the contract ended.
Background to Funeral Claim Declined
Mrs X got a funeral plan to cover herself, husband, children, and some of her extended family members in 1999. Six years later, the deceased died unnaturally and so a claim was put in place. The company declined the claim on the grounds that the divorce nullified their liability.
They had, as their evidence in the form of :
- A final order of divorce that had been issued by what was then the Supreme Court of Bophuthatswana and
- also, an affidavit that the deceased signed in 2006 confirming that the divorce was legal.
Mrs X denied the validity of the evidence and provided written proof from the NPA, in March of 2005, regarding a fraud case that had been put in place over the deceased before he died.
The basics were as follows:
- They had investigated the police file and held that the document looked fake.
- The accused (her now deceased husband) intimated that he has begun divorcing Mrs X and that he had been given the relevant document by his now deceased attorney.
- It was later found that the deceased’s file with his attorney was destroyed.
What the NPA Thought
The conclusion drawn by the NPA was that the decree of divorce would be invalid. This meant that the marriage was still intact.
The reason that they had not, at the time, prosecuted her husband was that there was no evidence that he did not believe that the document was legitimate.
Mrs X and her Divorce
It was also brought to light that Mrs X had applied for a divorce order. This order was issued in the same year, same court and with the same case number, but the dates and parties to the agreement were different.
The Ombudsman’s Ruling
This was quite the interesting case. On closer inspection, the Ombudsman highlighted to the insurer that the court order received from Mrs X clearly shows something was not right. You would never have two completely different cases, with different parties, being lumped under one case number.
The Ombudsman went on to ask that the insurer checks with the court about the relevancy of this information.
Funeral Claim Declined – Result
The insurer offered to pay the claim out and the matter was closed.
So never just accept that the claim is declined, you do have recourse with the Ombudsman.