THE FACTS
Sipho Nkosi took out a funeral policy with an insurance company in February 2016 for his wife and his twin brother.
Two months later, his wife died. Mr Nkosi lodged a claim with the insurance company in April 2016.
His claim was rejected by the insurance company as she died during the waiting period.
Mr Nkosi disputed this with the insurance company, alleging that he was not told about the waiting period when he bought the policy.
The insurance company informed him that they had listened to the voice recording made when he first took out the policy. The voice recording confirmed that he was informed telephonically of the waiting period. The insurance company even offered to give him with a copy of the recording.
At the time, Mr Nkosi didn’t take the dispute about the rejection of his claim any further.
STRIKE BACK LEGALLY
Scorpion Legal Protection contacted the insurance company, pretending to be enquiring about their policies and waiting period.
We were informed that, if an insured person dies as a result of an accident, automatic cover is given as per the first premium.
If the insured person dies as a result of natural or any other causes, there is a waiting period of 12 months.
Scorpion then contacted the insurance company again to discuss Mr Nkosi’s case. Unfortunately they refused to provide us with any information due to Scorpion being a third party to the dispute.
The prospects of the dispute being settled in Mr Nkosi’s favour are very poor. Firstly, the matter had prescribed as he had 90 days from the date his claim was rejected by the insurance company to challenge the decision and report it to the ombudsman.
Secondly, his wife was gravely ill when he took out the policy. As Mr Nkosi declined to get a copy of the voice recording, it is also doubtful that he was not informed about the waiting period.
SCORPION’S CONSUMER TIP
Always get a copy of your Schedule of Insurance in
writing and read it carefully.
Or get someone who can read explain the schedule if you can’t read.
This Schedule of Insurance will explain all the terms and conditions of your policy, including information about waiting periods.
If you are unhappy with the terms and conditions, you can query them with your insurer.
Remember that if you do lodge a claim and your claim is rejected, you have 90 days from the date of the rejection of your claim to lodge a complaint with the relevant ombudsman.
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