The National Financial Ombud rules in favour of a cancer patient against Discovery Life in a Severe Illness Benefit claim.
When it comes to Severe Illness Benefit claims, the illness itself - not the paperwork that confirms it - is the decisive event, the National Financial Ombud Scheme (NFO) has ruled in a cancer patient’s dispute with insurer Discovery Life.
The disagreement concerned Discovery Life’s decision to decline the complainant’s claim for the Severe Illness Benefit under the cancer category.
Discovery did not dispute the validity of the claim on its merits but instead relied on a technical defence, namely that the claim arose on October 21, 2023 when cover had lapsed due to unpaid premiums.
In response to an earlier provisional ruling by the NFO, Discovery Life said its policy terms unambiguously stipulate that a “life-changing event” occurs only upon objective medical confirmation and specifically, histological verification of a covered condition.
