Durban - University of Pretoria actuarial scientist, Dr Conrad Beyers believes that insurance company, Momentum, acted correctly in initially declining to pay out the life insurance claim of Nathan Ganas.
Beyers added that the decision to pay out the Ganas family could have ripple effects on the insurance industry as a whole.
Recently, Momentum came under fire and eventually resorted to paying out Ganas’s widow R2.4 million.
Initially, Momentum stuck to their guns and refused to pay out the life insurance policy stating that Ganas had declined to declare that he was diagnosed with Diabetes.
Ganas was killed during a hijacking at his Shallcross home.
It later emerged that Ganas had not disclosed his medical condition and as a result, Momentum said they would not issue the payout.
According to Beyers, insurance companies would not be sustainable if there are no strict and consistent conditions about claims pay-outs.
Nathan Ganas died from gunshot wounds in March 2017, but the insurance firm declined to pay a R2.4m policy claim after it was discovered that a health condition (high blood sugar levels) was reportedly not disclosed by the client.
According to Beyers, the public outrage about the rejection of the R2.4m claim points to a crucial need for customer education about insurance cover – the entire insurance industry (not only Momentum) is affected by this.
“A pilot with a health condition that can endanger the lives of passengers should not be allowed to fly passenger jets. It does not matter if the pilot ultimately dies of something else. Similarly, a person with a known health condition will often not be able to obtain life insurance. It does not matter if the ultimate cause of death is something else,” he said.
Beyers said it was unfortunate that Momentum has received public condemnation regarding the Nathan Ganas case.
“All other insurers would have done the same. The controversy highlights a very important and widespread issue around the general public’s understanding of the nature of insurance,” Beyers said.
He said policyholders who threaten to terminate their insurance policies will not be able to move to other insurers that will tolerate non-disclosure of pre-existing conditions.
“On the contrary, policyholders that terminate policies and apply for new insurance will most likely find that their premiums are much higher for the same level of insurance cover. This is because life insurance typically becomes more expensive the older a person gets. Also, people buying a new insurance policy may have developed new health or other conditions that may result in higher premiums – or no insurance cover at all,” he said.
Beyers said the entire insurance industry needs to take this case very seriously and find ways to educate or inform existing and potential customers about the nature of insurance.
“Even if an insurer is 100% correct, individual cases can cause significant reputational issues for any insurer due to the quick flow of (often false) information. The lack of proper understanding of the principles underlying insurance can be damaging to the insurance industry, and should be addressed,” he said.
Momentum has since made contact with Ganas's widow and agreed to make the payout.