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In 2025, 96% of life insurance claims were paid by South African life insurers. That’s a very high number and means your chances of a declined claim are very small. However, some South Africans still worry that an exclusion could affect a future claim. Understanding how exclusions work can give you greater peace of mind, so we’ve explained everything you need to know, including how to check which exclusions might apply to your policy.
What is an exclusion?
An exclusion is when a policy does not pay a claim because the specific event or reason for the claim is not covered. There are two main types of exclusions:
- General exclusions that apply to all policies
- Specific exclusions that apply only to a particular policy
General exclusions
These exclusions apply to all 1Life policies, as set out in the policy terms and conditions. Some apply for the full duration of your policy, while others apply only for a specified period.
Death due to suicide
Death due to suicide is an exclusion for a specific time period. For 1Life Insurance life cover policies it is excluded for 2 years, or 24 months, from the commencement date of the policy or an increased sum assured. If the life assured on a life cover policy passes away due to suicide within 24 months of the cover commencing, the claim will be declined.
On funeral cover policies death due to suicide is excluded for 12 months from the date of commencement of cover for the member.
An example: a life assured takes out cover for R1 million on 1 July 2023 and passes away due to suicide on 30 June 2024. The claim is declined because the death was due to suicide that occurred within the first 2 years of the policy.
Illegal activities
A claim is excluded if a life assured passes away while actively involved in an illegal activity. Illegal activities include, but are not limited to, the following:
- Fraud
- Theft
- Burglary
- Driving over the speed limit
- Driving under the influence of drugs and/or alcohol
Keep it legal and these won’t apply to your policy and a valid claim will be paid.
This exclusion does not apply if you are a victim of a crime such as if a life assured passes away when another driver under the influence of alcohol causes a fatal accident. However, if the driver, who is over the legal alcohol limit, passes away a claim on their life insurance would be declined.
Specific exclusions
These are when death due to a specific event is excluded only on a policy. These exclusions allow for a person who has one serious condition to be covered for other causes of death. Without them, a life assured could be offered only accidental death benefits which limits the instances in which a policy will pay out.
How specific exclusions work
A life assured who has had a recent heart attack may have an exclusion for death due to heart disease on their policy. If they pass away as a result of a heart attack, a claim would not be paid. However, if they pass away for any other cause of death such as cancer, a valid claim would be paid.
When an insurer issues a policy they will state if there are any exclusions and contact the life assured to let them know there is an exclusion. The life assured is then given an opportunity to accept or reject the policy. Your policy schedule will have details of any specific exclusions.
Good to know: most 1Life Insurance policies do not have these types of exclusions and will pay valid claims for all causes of death.
What about waiting periods?
Life and funeral cover policies may have waiting periods for death due to natural causes. In general, death due to accidental causes is covered from the date of commencement of the policy on 1Life Insurance life and funeral cover policies. Death due to natural causes, such as an illness like cancer, may only be covered after a certain time, such as 6 months from the date of commencement of a funeral policy. In addition, if medical tests are required, such as an HIV test, policies may only cover accidental death until the test results have been submitted and reviewed. You can read more about waiting periods in this blog.
Review your policy exclusions
Check your policy documents to see if any exclusions and waiting periods apply to your cover and chat to a skilled 1Life consultant if you have any questions. You can download your policy schedule on the online policyholder portal or WhatsApp service centre.