How to ensure your risk cover gets paid out

By Janice Roberts

Life is full of unpredictable moments. Although we can’t prevent many of them, we can at least plan for them.

“Buying risk cover is a great step towards making sure that your dreams and your family’s dreams are financially protected against any unforeseen events,” says Jaco Gouws, Protection Product Head at Old Mutual Personal Finance. “However, real peace of mind comes with knowing that your insurer will keep its promise when it’s time to pay your claim.”

According to Gouws, good insurers always look for reasons to pay claims, because they understand that it makes a great difference in their customers’ lives. “Old Mutual paid out an overall of R9.28 billion in underwritten, non-underwritten and corporate claims in South Africa in 2016.”

Gouws sets out some practical tips to ensure a positive outcome for your claim:

· Know what you’re covered for. It’s important to know what you can and cannot claim for under the type of cover you’ve bought. This information is normally stated in your contract. Submitting the right claim under the right type of cover will positively influence the outcome of your claim. For example, don’t submit a claim for a broken wrist under your severe illness cover.

· Double-check your application documents and contract. Ensure that all the information you provided is recorded correctly and that you understand the contents of your contract. If there is anything that is unclear, make sure to ask your financial adviser for clarity, or phone your insurer.

· Notify your insurer of any changes to your health. If there are any changes to your health status while you’re waiting for your application to get approved, inform your adviser or your insurer. These changes will need to be reflected on your policy and will help ensure that your claim is honoured according to its terms and conditions.

· Never withhold information from your insurer. Make sure you answer all questions about your lifestyle, your health and your family’s medical history honestly. This information helps your insurer assess the amount of risk they can take on, and decide on the amount of cover they can offer you at an appropriate premium. Failure to disclose this information could lead to your claim being declined at a later stage.

According to the 2016 Old Mutual claims statistics, 4% of claims were not paid due to various reasons such as the benefit definition not being met, non-disclosure, general exclusions, suicide exclusions which apply in the first 2 years of the policy, underwriting exclusion and fraud.

Gouws advises: “Honesty and asking for help from your financial adviser to understand your contract are the cornerstones of a successful claim. Speak to your financial adviser today to make sure that you’ll be covered should the unforeseen happen.”

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