Funeral Policy At Capitec Bank refuse to pay out because of 5 days.

This is how they catch you with funiral policys. 
I would like to thank The Onbistman for the great service. 
For the rest of the involved parties i have no comments for. Dear Ms Kuun
Our previous correspondence refers.  This complaint has been allocated to me for evaluation. 

 

We extend our condolences to you on your sad loss. 

 

We have noted that you were unhappy with the insurer’s decision to decline the claim for your late daughter.  You felt that they were being unfair to her, as she died 5 days before the end of the 6-month waiting period for natural death.  You confirmed that she had discussed the policy with Capitec on the 17/09/2018 and that the issuing was delayed until the 19/09/2018.  You were of the opinion that the insurer should’ve considered 90% of the claim, as the death occurred 5 days before the expiry of the 6 month waiting period.

 

The insurer has advised that the cover inception date was the 19/09/2018, and the 6 month waiting period expired at midnight on the 18/03/2019.  As the death of Late Natasha Kruger occurred on the 14/03/2019, which was within the 6 month waiting period for natural death the claim was declined.  The insurer further advised that if the deceased had cancelled a funeral policy with another company to take their Capitec policy, they would’ve waived the 6 month waiting period.  They advised that you were unable to provide them with this proof, so it was assumed that your daughter did not cancel another funeral policy to take the Capitec policy.

 

I have noted the following:

 

·         Late Natasha Kruger worked in Dubai until 25/07/2018, when she returned to South Africa.

·         She was unemployed upon returning to South Africa.

·         17/09/2018 – She approached Capitec about a Funeral Policy.

·         19/09/2018 – Capitec issued a funeral policy for Natasha Kruger.

·         The policy provided R 56 020.00 death cover for a monthly premium of R 50.00.

·         The policy was subject to the following Exclusions:

o   

 

o      

·         The insurer has confirmed that you were unable to provide proof that the deceased enjoyed cover under another funeral policy at least 1 month before taking the Capitec policy.

·         If the insured life had died of unnatural causes after 1 premium had been paid the full benefit would have been payable.

·         The deceased died of natural causes within the 6 month waiting period applicable to the policy. 

·         The waiting period would have expired on the 18/03/2019. 

·         If the policy had been issued with the issue date of 17/09/2018, the 6 month waiting period would have expired at midnight on the 16/03/2019.  The death would still have been within the 6 month waiting period. 

 

Although we have empathy with your situation, we must confirm that the insurer has declined the claim within the policy terms and conditions.  If the death had occurred from unnatural causes the full claim would’ve been considered after 1 premium had been paid.  We regret to advise that we cannot instruct the insurer to settle the claim. 

 

The ruling set out above is of a provisional nature.  In accordance with our usual practice each party is given an opportunity until 25/06/2019 to place new information before us and to make new representations to us before we proceed further with the complaints handling process.  Any response received from a party will be regarded as that party’s only response, unless otherwise indicated.

 

If we do not hear from any party by 25/06/2019 we will assume that neither party challenges the provisional ruling and we will then close our file.

 

REgards