Non-disclosure could mean rejected claims

A beneficiary’s claim for a R6 million life insurance policy was declined by a South African insurer in 2016. The beneficiary disputed the decision and took the matter to the High Court, which, in 2025, ruled in favour of the insurer because there was material misrepresentation and non-disclosure. The life assured reportedly misstated her income on the application, claiming she earned over R30 000 a month when her actual earnings were less than R6 000 a month. Based on her actual income, the life assured would have qualified for a much smaller sum assured and would not have been granted the R6 million cover. The life assured also didn’t disclose that she had applied for life cover with another insurer at the same time.

The High Court decision confirms that insurers have the right to reject claims when there is material non-disclosure and misrepresentation. The beneficiary is now without funds from a policy pay-out and has to pay legal costs. Full disclosure ensures that your loved ones are protected and are taken care of when you are no longer around.

Insurers like 1Life Insurance want to pay valid claims as quickly as possible, but they also need to ensure that the terms and conditions of the policy are followed and that they pay the right claim to the right person.

A closer look at non-disclosure and how you can avoid it

More than 95% of South African life insurance claims are paid each year, but over 30 000 individual claims are declined.  Life insurance claims are declined when the policy terms and conditions have not been met. The most common reason for a claim being rejected is non-disclosure and misrepresentation, such as when a health condition is not disclosed.

When there is non-disclosure, claims may be declined or reduced. We explain what it means to fully disclose and which facts your insurance company must know so that when the time comes, your valid life insurance claim can be paid quickly and in full.

What you need to disclose to your insurance company

Your insurance company needs to know the details of:

Your health

You must tell your insurance company if you have any serious illnesses such as cancer or a chronic condition such as high cholesterol. Your insurer also needs to know if you suspect you may have an illness or chronic condition, for example, if you show all the symptoms of having heart disease. Best practice is to answer all questions truthfully and honestly and in full.  

You can read more about disclosing health conditions in this blog.

Your income

Your insurer needs to know what you earn in total, such as a salary and, for example, R3 000 a month from a side-hustle. If you overstate your income, your claim may be declined or reduced.

Your occupation

Tell your insurer where you work and what your work involves, specifically if there is anything that adds to the risk such as working in a power station, doing manual work or travelling every day for business.

Your hobbies

Having a dangerous hobby can affect your cover, such as paragliding or scuba diving. You must give your insurer details of these hobbies.

You can read more on dangerous pursuits and your life cover in this blog.

Details of any other life insurance policy

If you have, or are applying for cover with another insurance company, or if the cover you are applying for is to replace another policy, you should let your insurance company know.

What a declined claim means for your family

Declined life cover claims put families in financial distress.

Your life insurance policy pay-out gives your loved ones financial security, ensuring they can cover future expenses such as housing costs, transport, food and education when you are no longer around. But if the claim on your life policy is declined your family may struggle to maintain their standard of living. Unfortunately, most South African families would have to downscale and reduce expenses by as much as 30% if an income earner passes and the claim on their life cover policy was declined. 

When do you disclose?

You disclose when you apply for life cover, or an increase in the sum assured or if you wish to reinstate a policy. The questions on the application - or those asked by a consultant over the phone or by your financial adviser- will guide you and help you disclose. Take your time answering them so you know your answers are complete and accurate and be sure to ask if there is anything you don’t understand!

At 1Life Insurance, we need to know if at any time:

• Your occupation changes
• You take up or stop smoking
• Your start participating in dangerous sports or activities
• You travel outside of South Africa

What if you haven’t disclosed on your application?

Talk to your insurer so they can see if your cover and/or premium will be affected. For your 1Life Insurance policy, you can contact a skilled 1Life Insurance consultant who can help you with your query.

Your life cover can change your family’s life

Your policy can change your loved ones’ lives for the better. But if a claim is declined because you haven’t shared material information they may face financial hardship. Make sure your loved ones can claim and have financial security by fully disclosing important information.