Claims
Guidelines on processing of claims
Claims by Policyholder and officially nominated Beneficiary only
Fully completed Claim Notification Form
Proof of Death (Natural, Unnatural/Accidental or Suicide)
Claimant's certified ID copy
Deceased Certified ID copy
In case of claim payment to a third party, certified ID copy of the recipient (and a declaration of Indemnity)
PROOF OF DEATH SUPPORTING DOCUMENTS:
A copy of the Notification of death, AND
Original computer produced or certified Death Certificate, OR Original or certified copy of unabridged Death Certificate, OR
CLAIMS Supplementary Explanatory Notes
ALL supporting documents are subject to confirmation satisfactory to the Insurer.
INSURER reserves the right to request further documentation or information as it may deem necessary to accurately assess the claim.
Submitting a CLAIM
Authority and limitations in respect of lodging a claim:
- Main/Principal Member - lodges all claims in respect of the Policy Dependents
- Beneficiary - must be OFFICIALLY nominated on the Main/Principal Member’s Application Form (may only lodge claims in the event of the Main/Principal Member’s death)
- Employer - lodges all claims in respect of the deceased employees (Employer Plans only)
i) Please note that all persons insured under the policy must be related to the Main/Principal member and/or policy payer, and
ii) The Main/Principal member and/or policy payer must have an insurable interest in all insured persons under the policy.
Additional Documents - Payslips and Bank Statements
1. Copy of Main/Principal Member’s most recent payslip for the pay period immediately prior to death or month in which the death occurred (Employer Plans only).
2. Copy of the beneficiaries' bank statement reflecting Bank name, account number and account holder’s details
Driving License Cards are not acceptable as proofs of identity.
Name, signature, organization, date, address and telephone details to be clearly indicated on documents certified by a Commissioner of Oaths (SAPS).
Further supporting documents - Children
• If the child has attained age 22 (twenty two) years but has not yet attained age 26 (twenty six) and is a full-time student, the following must be submitted:
- Confirmation satisfactory to Insurer (last academic report from a recognized educational institution), to confirm full-time study at the time the death occurred. Part-time and correspondence students are not covered.
• Children who are mentally retarded or totally and permanently disabled (as determined by Insurer), before age 22 years, who are unable to care for themselves, any one of the following must be submitted:
- Confirmation satisfactory to Insurer of a State Disability Grant
- Medical Aid application of Principal Member
- Medical Report
• An illegitimate / adopted child: proof of such illegitimacy or adoption must be attached.
• Where the surname of deceased (spouse or child) is different to that of the Principal Member, kindly provide an explanation for the difference in surname and submit supporting documents. Affidavits are not accepted for children over 1 (one) year old.
Spouses and Children - Surname Difference
In respect of the surname difference of a Spouse, any 2 (two) of the following:
- Marriage Certificate
- Letter from Tribal Chief, signed and stamped.
- Company Beneficiary Nomination Form. The document must have been completed at least six months prior to death (Employer Plans
only).
- Letter providing customary and/or common law marriage from the Department of Home Affairs (not an affidavit).
- Medical Aid card reflecting dependants’ details.
- Any legal policy document where the spouse has been nominated at least 6 (six) months prior to death.
In respect of the difference of surname of a Child - any 2 (two) of the following:
- Birth Certificate reflecting both parent details ( BI-19)
- Adoption papers
- Baptismal Certificate reflecting both parent details (for Eligible Children age 5 years and younger).
- Marriage Certificate and Birth Registration in respect of Stepchildren
- Medical Aid Membership card reflecting the Eligible Child’s details
Accidental Death Benefit
In respect of an Accidental Death Claim, together with the documentation as required for the category of a Main/Principal Member, Spouse, Child and/or other Dependant, a medical report from a medical specialist and/or a police report must be submitted, clearly indicating how, where and when the bodily injury was sustained.
- A police report is compulsory for all the unnatural deaths.
- No Waiting Period will apply for Accidental Cover, provided first premium has been received.
- Insurers reserves their rights to pay Policy Benefits in the event of the occurrence of death arising directly or indirectly from, or traceable to war, riots, civil commotion, terrorist activities, willful exposure to danger, the Policy member being under the influence of any drugs or alcohol; participation in any criminal act; radioactivity or nuclear explosions or intentional self-inflicted injury.
- Insurers also reserves their rights to honor policy payments if it is proved that the Policy Benefit has been based upon an incorrect statement of age or date of birth of any Policy Member, OR even in the event of misrepresentation or non-disclosure by or on behalf of the Applicant of any fact material to the assurance.
