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Beyond the numbers: Momentum 2014 claim stats

By Staff Writer
If you've ever wondered what the chances are of being diagnosed with breast cancer, or what unnatural causes most people in South Africa die from every year, the figures from Momentum's claims stats make for interesting, if scary reading, and can certainly give you some insight.
 
Of the death claims awarded 35% came from cardiovascular causes, 20% from cancer, 12% died of respiratory complications, while nine percent were nervous system related, and a further nine percent were due to unnatural death claims, such as motor vehicle accident, suicide and murder.
 
If you are wondering whether insurers pay out for suicide related deaths the answer is 'yes they do', but they do not pay out for suicide related claims in the first two years of taking out the policy.
 
This, some say, is supposed to serve as a deterrent. But mental illness is complex and once the two years are up the insurer's stats show that sadly 20% of unnatural deaths are as a result of suicide, making it second on the 'Causes for unnatural death claims list' for 2014.
 
The top 'unnatural' killer, according to Momentum, is motor vehicle accidents, which makes up 49% of all unnatural death claims.
 
It's clear that more still needs to be done to help people suffering from mental illness and reduce the number of deaths on South Africa's roads.
 
Terminal illness
 
Momentum added that 98 terminal illness claims were also paid, totalling R82 million. Cancer was the primary cause for these claims.
 
When it comes to critical illness claims, cancer is again the top reason for clients submitting a claim.
 
Cardiovascular critical illness made up 20% of claims while nervous system related claims made up 14%.
 
When it comes to breast cancer, Momentum's stats showed that most of the claimants were aged between 30 and 50 years.
 
The good news, though, is that many of the company's claims are from early stage cancers – possibly because of timely intervention and managed care it said.
 
When it came to disability claims 21% were from musculoskeletal causes, 15% were due to cancer and 12% were nervous system related causes.
 
The claims stage
 
Of course not all claims are paid and it's clear that some people try to make fraudulent claims or aren't truthful when it comes to providing insurers with all the necessary information.
 
So when it comes to claims stage insurers have the right to refuse to pay a claim if it is found that clients were 'economical' with the truth.
 
Momentum Myriad said it repudiated only one percent of all claims. It defines repudiation as 'a breach of contract by the one party that justifies cancellation by the innocent party'.
 
But at times it's the insurer that can be in the wrong, and it's important to fight your case if you feel that an insurer is being unfair with your claim.
 
Momentum said it would never discourage clients from taking their cases to the office of the long-term insurance Ombudsman.
 
The office of the Ombudsman received in the region of 11 023 long-term insurance complaints across the industry in 2014. According to the insurer there was no ruling against Momentum Myriad.
 
Momentum's claim stats make for interesting reading, but it also brings you to the realisation that a lot of these deaths could have been prevented.
 
Real changes that work to reduce road deaths and that help people lead normal lives following a depressive episode, for example, can't be introduced soon enough.
 
The question remains though, is it the role of government to introduce such changes or should private industries do more to incentivise people to drive safely on our roads and lead healthy lives?
 
More claims facts:
 
Momentum's largest claims during 2014 included:
 
·         A death claim of R22 million
·         A terminal illness claim of R 7 million
·         A critical illness claim of R 4,7 million
·         A disability claim of R 10 million
·         An income disability claim of R 315 000 per month

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