In recent weeks, an article was published on Fin24 where a life policy claim was declined owing to a client's non-disclosure of a pre-existing medical condition.
Widow Renei Kruger's claim from her murdered husband's life policy was eventually honoured by Old Mutual. This after the insurance company had initially rejected it because he had supposedly not declared a pre-existing diabetic condition.
Sumari and Roger Hendricks joined 702 host Azania Mosaka to discuss repudiated claims. Hendricks had the same experience as Kruger following her father's death. As a result, she established her own insurance company that would deal with such claims.
Hendricks says her father committed suicide. When they submitted his claim, Momentum asked for permission to obtain his medical aid claim history and contacted every doctor that he has ever been to. Doctors were asked to write reports on the reasons for consultations.
"One doctor that my father saw (only once) said that he should watch his sugar and should come back in a few weeks to retest. My father never went back and he simply adjusted his eating habits going forward", says Hendricks.
Some brokers/advisers that I have spoken to, inform their clients to only disclose their medical history for the past five years and nothing more.— Sumari Hendricks, Director at DiscloseAll
When you lodge a claim with the insurance company, the very first thing they ask for is permission to pull your medical aid claims history from your medical aid provider. As soon as this information is available to them, they go through each and every single entry, sometimes as far back as fifteen years (depending on how long you have been with your medical aid provider). They then further request medical reports (PMA reports) from every doctor on your medical history.— Sumari Hendricks, Director at DiscloseAll
If there is a doctor/specialist in your medical history and you have forgotten to mention this doctor/specialist on your disclosure to the insurance company at inception, they have the right to repudiate your claim, if this is a material non-disclosure, explains Hendricks.
It all comes down to the insurance company determining the risk of the client at the inception of the policy. If they have all the information on a client they can make a clear decision on whether they are going to accept the client's risk, load it, or decline it.— Sumari Hendricks, Director at DiscloseAll
To hear the rest of the interview, listen below: