November 28, 2018

The Rainbow Nation gathers momentum

 

Life assurer Momentum took a beating on social media last week because of its refusal to pay the death claim for the policy of Nathan Ganas, who was tragically murdered two years ago during a botched hijacking in the driveway of his home.

Momentum repudiated the claim because of a non-disclosure clause in the insurance policy – Mr Ganas had apparently been diagnosed with raised blood sugar levels, but did not disclose this in his application.  What incensed the public was that Mr Ganas’s death was unrelated to his blood sugar levels. Momentum was seen as opportunistic for relying on the non-disclosure when the medical condition had nothing to do with his death.

 

The matter had been adjudicated by the Ombudsman for Long Term Insurance, who found in favour of Momentum. The Ombudsman’s ruling was based on the question of whether Momentum would have issued the policy if it knew about Nathan Ganas’ sugar levels – the answer to which, according to the Ombudsman, was no. In other words, the Ombudsman reasoned that if Momentum had known about the elevated blood sugar levels, it would not have issued the policy.

I think that the Ombudsman got it wrong. Life assurers do not lightly turn down the opportunity to collect premiums. Sure, they (rightly) take steps to ensure that they do a proper risk assessment, which is why they ask the questions and which is also why the questions must be answered truthfully. But I have certainly never heard of a policy being refused due to a pre-existing condition; it might result in a higher premium, an exclusion or a waiting period, but not an outright refusal. I have had a couple of experiences of this:

  • A friend of mine was diagnosed with stage 4 cancer a few years ago. He had no life insurance. A life assurer insured his life with full knowledge of his condition, but with a waiting period of 2 years – that is, he had to live for at least 2 years in order for the policy to pay out. Sadly, he succumbed to the illness a few months before the end of the waiting period.
  • I take Cipralex, an anxiety medication.A policy that I recently applied for was issued, but subject to the condition that it won’t pay out if I die or become disabled due to anxiety or depression related reasons (read: suicide).

So, the likeliehood is that Momentum WOULD have insured Mr Ganas’s life if it knew of his elevated blood sugar levels, but would have excluded diabetes related conditions. The point is that he would have had a policy in place and it would have paid out if he died for reasons unrelated to his pre-existing condition.

Commenting on its ruling, the Ombudsman said:“We do want to help people to the extent that we can, but we cannot make decisions which are not based on law and fairness. We can’t decide based on emotions or sympathy.”  While the ombudsman’s decision was certainly based on the law (of contract), I can’t see where fairness came into the equation.

The former public protector, Thuli Madonsela, captured it beautifully when she responded to Momentum’s tweet that their decision not to pay was correct and vindicated by the Ombudsman:  “This answer”, tweeted Madonsela, “is perfectly legal.  The question is, is it just and ethical?

 

Applying the letter of the law is not always fair. Sometimes we have to suck it up, accept it and move on.  But sometimes we have to stand up and say that that is simply not good enough – we demand fairness.  And that is exactly what South Africans from all backgrounds did in support of Mrs Ganas.

In these times when zealots from both extremes of the political spectrum seek to divide us, I find it deeply encouraging that ordinary South Africans are so quick to transcend race and background and stand united with a fellow South African against an injustice.

The zealots might deny it because it does not support their narrative – but we ARE the rainbow nation!

 Robin Twaddle

 

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