Most insurers will proudly boast that they have annually paid out somewhere between 90% to 98% of claims – maybe even 99%. As a consumer, you can only hope you don’t fall in the declined claims category – and underwriting is one of the keys to this.

In a nutshell, underwriting is part of the process when you take out the policy, and includes the assessment the insurer makes regarding the risk you pose based on all the information you supply.

Unpaid insurance claims can often be traced to inaccurate or absent information submitted during the underwriting process.

At a media roundtable this week, Liberty’s managing executive for retail solutions, David Jewell, told journalists that although more than 94% of claims were paid out last year, 5.2% were declined due to the claims not meeting the necessary requirements, with 0.3% rejected due to material non-disclosure.

What should you disclose?

Jewell says disclosing your risk factors appropriately is vital because this affects your ability to successfully claim on your insurance policy.

“Full disclosure during the underwriting process gives you peace of mind that, having disclosed everything you should, you can reasonably expect a successful claim outcome should an adverse event happen that changes the quality of your life,” adds Lisa Gibbon, Liberty’s divisional executive for onboarding.

“It is important to note that we assess risk at a point in time, considering what is known at the time of application.”

Gibbon explains that when you take out an insurance policy, either your insurer or your broker will take you through a series of questions related to your medical and financial health, and also your occupation, lifestyle and hobbies. Sometimes, people omit certain information during this stage, and this might impact on the claim stage.

“One of the major issues linked to not disclosing pertinent information upfront is that (if this is picked up) at the claim stage, this may result in repudiation of a claim and then the very essence of insurance is not fulfilled,” says Boitumelo Mothoagae, divisional executive: claims management at Liberty.

Typical reasons for your life insurance claim being rejected include the medical condition not being covered or not meeting the criteria for a valid claim, exclusions being applied, discovery that crucial details were not disclosed at inception, or finding out at the claims stage that the policy is inactive, says Mothoagae.

Short-term insurance claims

On the short-term insurance side, Youlon Naidoo, executive head of claims and procurement at MiWay Insurance, says you should regularly review your policy to check that any new or upgraded assets are adequately accounted for.

When it comes to short-term insurance claims, Naidoo advises that you have your policy information on hand, as well as:

• A South African Police Service case number when damage or loss has been incurred as a result of criminal activity (or a car accident).
• Photo evidence that can give insurers a clear view of what occurred. You should try to take as many photos as possible, from multiple angles, so that your insurer can assess the event/accident scene.
• Specific details on what occurred and how – this will help validators in providing an accurate and speedy assessment.

“Validators are appointed by insurers to assess the facts of each case, collate damage reports and contact any bystanders or authorities who can assist in providing clarity on how the incident occurred,” Naidoo says, adding that once a validator has been assigned to your claim, s/he may request further documents such as the service history of your car or a valuation certificate for your jewellery.

“These are documents you should have safely stored so you can easily access them when you put in a claim,” he says. DM