Health and insurance group Momentum is sticking to its guns on the decision to reject a R2.4-million life insurance payout for a Durban man due to non-disclosure of his health condition.
Although the man who has been identified as Nathan Ganas died from gunshot wounds, the insurance group rejected his policy claim after it was discovered he had high blood sugar levels.
The company, which also provides a range of financial and short term insurance services, has attempted to clarify its position, with an emphasis that failure to conduct proper checks would “indirectly encourage the practice of non-disclosure”.
“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.”
Ganas, 42, was killed during a hijacking in the driveway of his home in March last year, and his wife has maintained that she was not aware of his condition, according to a Daily News report.
The policy was taken out in 2014 and he took the required HIV test.
The decision to reject the claim has since drawn public wrath, with the public, including prominent journalists, taking to social media to express their outrage, questioning how the company arrived at the conclusion that Ganas suffered from raised blood sugar levels after taking out the policy.
How did we go from a hail of bullets to elevated blood sugar levels? Was
#Momentum looking for a way to NOT pay? Are you convinced by CEO Johan Le Roux’s explanations? Why is non-disclosure such a big deal here? #702Breakfast
— Bongani Bingwa – Broadcast Journalist (@bonglez)
November 19, 2018
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.
“In line with our standard practice in non-disclosure cases where we repudiate the claim, we will reimburse the premiums paid over the course of the contract.
“The post mortem report states that he (Nathan) had died of gunshot wounds and not diabetes,” his wife Denise told Daily News.
South Africa: the country in which it is advisable to be shot to death with brushed teeth, wearing a good suit, and with normal blood sugar levels in order to get paid out by insurance.
— IG: richpoplak (@Poplak) November 19, 2018
“The strict requirement for full disclosure is a fundamental principle of insurance, and a breach of this duty, however innocent, obliges the insurer to decline the claim and to deal with the policy as if the non-disclosed information had in fact been disclosed.”
This #Momentum story actually brings the legalities of the entire insurance industry into sharp focus.
Today, Momentum- tomorrow it could be any of the others – they all do this.
The industry as a whole must be compelled to put ethical policies in place – coz this here is WILD!
— marang setshwaelo (@marangdream) November 19, 2018
“Unfortunately, in this instance, the client did not disclose material information,” it said.
Momentum advised that if a client was not aware of a medical condition prior to the commencement of their policy, it is not viewed as non-disclosure.
“If a client finds out later that they have a condition, they are also not obliged to notify the insurer regarding the existing policy, but will have to notify the insurer if they take up additional cover.” — Fin 24