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Tips for successful claims

Posted  May 7, 2019

Claiming on your 1Life insurance policy should be quick and easy. Simply follow our how-to guidelines for a successful claim.

If you’ve suffered an accident, been diagnosed with a critical illness or had a death in the family, you may have a claim on your long-term insurance policy.

We want to make claiming in this stressful time as easy and fast as possible so here is everything you need to know to make sure your claim is successful and hassle free. We’ve listed the information by policy type – funeral cover, life cover, disability and dread disease - so you can find what you need to know for your particular claim.

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Funeral policyWho can claim?
The beneficiary listed on the policy if the principal member has passed OR the principal member if any other member insured on the policy has passed. Make sure you tell your beneficiary and insured members where the policy and your personal documents, such as your ID, are, and how to claim.

When can you claim?
When a person insured on the policy, a member, passes on, you must claim within 6 months of death.

How do you claim?
Call us on 0860 10 51 96 and we will assist you, send any forms you need to fill in and let you know what documents we require.

When and where are claims paid?
We pay valid claims into South African bank accounts as soon as we can. Claims for 1Life funeral policies are paid within 24 hours of receiving all the documents we need.   Claims are paid into the beneficiary’s bank account if the principal member passes, or into the principal member’s bank account if an additional member passes. We will need proof of the beneficiary’s bank account, such as a copy of a bank statement, not older than 3 months.

What can cause a problem?
Waiting periods: Death as a result of an accident, such as a car accident, is covered from day 1. Death from natural causes is covered after 6 months of a member being insured.  So, if you insured a member on your policy in May, a claim for their death from a natural cause would only be paid if the death occurred six months, or longer, after May.

Claim for a child over the age of 21: Children can be insured on the policy if they are under the age of 21, or under the age of 25 and full-time students or disabled. So, if a claim is made for a child who is over the age of 21, the claim may be denied. When your children reach age 21 and they are not full-time students, check if they need their own funeral policy.

Suicide: Claims may not be paid if the member died as a result of suicide within the first 2 years of the policy.

Illegal activity: If a member passes away while involved in any illegal activity such as committing a crime the claim may be rejected.

Unpaid premiums: The policy needs to be up to date and all premiums paid.

Residing outside South Africa: If the principal member resides outside South Africa for longer than 60 consecutive days without our knowledge the claim may be denied.

Life cover policyWho can claim?
The beneficiary or beneficiaries listed on the policy. Remember to tell your beneficiary or beneficiaries where the policy is and how to claim. If there is no beneficiary listed the executor of the estate will have to claim.

The life assured may claim a terminal illness benefit on their life policy if they have been diagnosed with a terminal illness and have less than 12 months to live.

When can you claim?
When the life assured listed on the policy passes on, or a terminal illness is diagnosed. A death claim must be made within 6 months of the death.

How do you claim?
Contact us on 0860 10 51 96 and we will let you know what forms you need to complete and what documents we require.

When and where are claims paid?
Claims are paid into South African bank accounts within 10 working days once we have all the documents we need. Claims for death are paid into the beneficiaries’ bank accounts so we will need proof of the bank accounts such as bank statements, not older than 3 months. If beneficiaries are not yet 18, we pay into either the trust’s bank account that has been set up on the death of the life assured,  which the trustees will open, or the Guardians Fund.

For a terminal illness benefit the claim will be paid into the life assured’s bank account.

What can cause a problem?
Waiting periods: All 1Life life policies have a 2-year waiting period before a claim from a suicide death will be paid. Some policies have waiting periods before they pay for death due to natural causes such as cancer. You can find this information in your policy schedule.

Crime or illegal activity: If the death occurred while the life assured was committing a crime or engaged in illegal activity the claim may be denied.

Exclusions: Claims when death was due to a condition that has been excluded may also be denied.

Hazardous pursuits: If the death is a result of a hazardous pursuit such as high-speed motor racing that has not been disclosed, we may reject the claim.

Unpaid premiums: The premiums must be paid.

Disability and expense protectorWho can claim?
The life insured on the policy or court appointed guardian or trustee if the life insured can no longer take care of their finances.

When can you claim?
When a disability occurs, such as you lose a limb. The 1Life policy book  and your policy schedule have all the details of conditions that can be claimed for on disability policies. You must claim within 3 months of the disability occurring.

How do you claim?
Contact our claims division on 0860 10 51 96. We will let you know what documents and medical records we need.

When and where are claims paid?
Claims are paid into South African bank accounts within 10 working days once we have all the documents we require. Disability claims are paid into the life insured’s bank account. If the disability is so severe the life insured cannot make financial decisions a trust will need to be set up to take care of their finances and we will pay the claim into the trust’s bank account.

What can cause a problem?
Condition not covered: Disability policies cover certain conditions so if a claim is made for a condition not covered the claim may not be paid.

Waiting periods: Claims made for events that occur in waiting periods may not be paid. Details of any waiting periods will be on your policy schedule.

Exclusions: A claim made for a condition specifically excluded on the policy may be rejected, such as claiming for disability after a heart attack if heart attacks have been excluded from the policy.

Hazardous pursuits: If a disability occurs as a result of a taking part in a hazardous pursuit such as base jumping that has not been disclosed, the claim may be rejected.

Insured is older than 65: Occupation based disability cover is not available after the age of 65 on 1Life policies so a claim for disability when the life insured is over 65 may not be paid.

Previous claim: If there has been a previous disability claim and the sum assured has already been paid out a further claim would be rejected.

Crime or illegal activity: If the disability occurred while the insured was involved in criminal or illegal activity such as a high-speed car chase fleeing a crime scene, the claim may be rejected.

Unpaid premiums: Premiums must be paid up to date. 

Dread diseaseWho can claim?
The life insured listed on the policy.

When do you claim?
When a dread disease is diagnosed. Claims must be made within 3 months of the diagnosis.

How do you claim?
Contact us on 0860 10 51 96. We will let you know what forms you need to fill in and what medical reports and documents we require.

When and where are claims paid?
Claims are paid into South African bank accounts when we have all the documents we need. Dread disease claims are paid into the life insured’s bank account.

What can cause a problem?
Condition not covered: If the dread disease claimed for is not covered on the policy the claim may be rejected. Your policy schedule and 1Life policy book have the details of what dread diseases are covered.

Survival period: If the life insured passes from the condition within 28 days of the diagnosis the claim may be rejected. 1Life pays dread disease claims if the life insured survives longer than 28 days after the diagnosis of the dread disease.

Exclusions: A claim made for an excluded condition may be rejected, for example lung cancer if it is excluded from the policy because the life assured previously had lung cancer.

Previous claim: If a claim has already been made and all the benefits paid any further claims would be denied.

Self-inflicted harm: If the dread disease is caused or accelerated by the life insured, for example excessive use of alcohol or drugs, this may result in a claim being rejected.

Unpaid premiums: Premiums must be paid and up to date.

A word on non-disclosureNon-disclosure is when you take out a policy and don’t tell the whole truth about any medical conditions or medication you are taking today or have taken in the past. You also need to disclose any travel or residence outside South Africa.

While it doesn’t happen a lot, non-disclosure is one the main reasons why claims are rejected. So make sure you tell us everything when you take out a policy, and when you review your policy check that you disclosed everything. If you have any questions about non-disclosure call us so we can discuss it and make sure you are covered and won’t run into any problems when you need to claim.

Final thoughtsYour 1Life insurance policy is there to give you peace of mind. We like to pay claims as quickly as possible so you can carry on with your life and not suffer too much financial distress. But there may be one or two cases where there are problems and delays so if you have any questions about a claim please contact us.

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