- Where the assured life was supposed to be medically examined but was not medically examined before death occurs.
- Where there is material misrepresentation, the validity of the claim is contestable.
- Where suicide occurs within the restricted period, say during the first 2 years of the policy. (This is to ensure that a person does not benefit from his own crime) Suicide clauses are not common in group credit/mortgage policies.
- Group Credit/Mortgage policies pay the outstanding loan
- Where death occurred through the criminal act of the assured or his agent. This is against public policy.
- Where foreign death (in countries engaged in war) is excluded from cover. This is to protect the Life fund of the company from disastrous claims.
- Presumption of death may also be excluded from Group credit Policies.
- Where fraud is suspected
- Where death occurs while the application is still being processed:
- If the sum assured is less than the free cover limit or non-medical limit. The decision to pay or not to pay will depend on the cause of death.
- Where the sum assured is higher than the free cover limit or non-medical limit, with medical obtained and deposit premium paid – Pay full sum assured less any balance premium if assessment is standard. Refund deposit premium less expenses if assessment is substandard.
- Where deposit premium was made but medical was not obtained before death. Refund the deposit premium less any expenses as there was no contract at all.
- Lastly, where premium is not paid until the proposer is sick. Claim should be repudiated as there was no contract all
- Where genuine omissions occur, the insurer may waive his right and settle claim in full or pay ex-gratia. The problem here is knowing which omission is genuine
