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Insurer rejects second cousin claim

Yet another insurance company is accused of rejecting a funeral cover claim on the basis that the deceased is not related to the beneficiary.

A month ago Sowetan reported on 1Life rejecting a funeral claim by Desiree Majanaga, who had taken a funeral cover for someone who was not a blood relative.

Zodwa Maloba, 42, of Eastvale in Springs, has complained about the same problem. She is accusing Sanlam Sky of rejecting her nephew's claim on the grounds that they were not related.

Maloba said she had a very small family of less than 20 people, including relatives. She said she approached a Sanlam broker, Cyril Pule, who advised her it was acceptable to take more than one policy for a family member as long as she did not over-insure them.

The mother of three said she took four funeral policies for her unemployed and orphaned nephew, Thabo Molukanele, in 2010.

Sanlam Sky accepted her application as the total payout of the four policies she took for her nephew did not exceed R90000 on Funeral Provider Plan and R50000 on my Choice Funeral Plan, which is their policy, said Maloba.

She said all the benefits added up to a maximum of R140000 which was payable per extended family member and the two products are also marketed like that by Sanlam Sky.

She also paid the agreed premiums without fail and submitted her claims in June on the death of her nephew.

Though the insurance paid out one of his policies, they refused to pay the remaining three on the grounds that she was not related to Molukanele.

Sanlam Sky told her they had investigated her claim and found that it was not valid as her relationship to the deceased did not fit the description of a family member.

"I don't know what method they used to arrive at that conclusion because they did not even take my DNA sample to eliminate him as a family member," Maloba said.

Maloba said insurances should interrogate relationships when clients sign up and not when they make claims. She added that they should not have a cover that catered for extended family members if they would later question the relationship of the same member.

"I am scared that they will question my relationship with my own children should I die tomorrow."

Nkateko Shivambu of the clients services department at Sanlam Sky said Maloba's policies were rejected because Malukanele was not related to her as defined by the policy she bought.

Shivambu said three of the claims were repudiated but one was erroneously paid by their claims team.

He said Maloba covered Malukanele as her nephew when taking out the funeral policies. But an external forensics company they employed discovered that the deceased was the second cousin to the client's mother.

The policy does not cover the second cousin relationships, said Shivambu.

He said, as a result, they refunded all the premiums collected from the client for the three policies after the claim was rejected.

Shivambu said Sanlam was not discriminating against Molukanele by excluding him in the definition of extended family.

He said families like the Malobas should cover other family members through non-traditional insurance products like stokvels or burial societies.