The adverts tell you that taking out life insurance is the best way to take care of your family should something happen to you.
Nathan Ganas took out life insurance in 2014, presumedly under this impression. Sadly, this turned out not to be the case.
Ganas was killed in a hail of bullets, trying to protect his wife, Denise, during a hijacking outside his home last March.
His 10-year-old daughter (now 12), Carmen, was also injured as bullets ripped through the front of the house during the onslaught, reports IOL.
Health and insurance group Momentum not only refused to pay the R2,4 million life insurance payout, but also initially demanded that Denise repay the R50 000 instant cash benefit that was used to pay for Nathan’s funeral, citing non-disclosure of a pre-existing condition (raised blood sugar levels) as justification.
When Nathan took out the policy, he did the required HIV test. He was also not being treated before he took out the policy for elevated blood sugar levels. His wife also points out that the postmortem revealed his cause of death to be gunshot wounds, not diabetes.
Momentum said Nathan Ganas had failed to provide all relevant information regarding his health.
That the cause of his death (being shot) was completely unrelated to a pre-existing condition (raised blood sugar levels), the insurer said, was “irrelevant, since he had an obligation to provide all relevant medical information to Momentum in the new business application process for the risk to be properly underwritten”. It said this entitled the insurer to reject the claim and to deal with the policy as if the non-disclosed information had in fact been disclosed.
“In this instance, if he (Nathan) had shared the relevant information when it was required, the underwriting decision would have been not to issue the cover and no claim would have existed,” said Momentum.
You can listen to an interview with the CEO of Momentum, Hillie Meyer, here:
[MUST LISTEN] The CEO of MMI, the holding company of #Momentum , Hillie Meyer says “it would be wrong to pay out” Listen to this incredible display of callousness, and PR disaster @Radio702 @CapeTalk —> https://t.co/8nEtotsbpk
— Eusebius McKaiser (@Eusebius) November 19, 2018
‘Incredibly callous’ his the nail on the head.
After facing public backlash on social media, Momentum rescinded their initial demand that the family pay back the R50 000 instant cash benefit and have returned the premiums paid towards the insurance.
Here’s Denise in an interview with IOL:
“I received a call from Stephen van Niekerk from Momentum [at] about 3pm today, he advised me that they had put the premiums into my bank account and they have made a decision to not ask for the R50 000 back for the funeral benefit.
“This case is still pending and I told him ‘Steven I’m not accepting your premiums, I am still fighting them’ and he said they have come to a decision regarding the premium.”
Fin24 reports that Momentum do not intend to go back on their initial decision. According to the company, the rejection of the claim was referred to the Ombudsman for Long Term Insurance, who ruled in favour of the insurer.
“Our position on this matter is the following, once we have evidence that a client has not acted in good faith, we rectify the matter in an objective manner, and in the interest of fairness to all our clients,” the company said in a statement.
“If we do not do so, we indirectly encourage the practice of non-disclosure. This will in turn result in a worsening claims experience which would ultimately increase the premiums for all our clients.”
Perhaps it’s time for a more in-depth conversation about how policies and their providers work. The same can be said for what is and isn’t covered by medical aid.
The ads make it look easy. The reality looks very different.
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