27 April 2018

What are the biggest medical insurance claims?

The highest claims over the past four years have been for unnatural deaths.

During 2017, the largest death claim was for R36.7 million, which was for a 48-year-old trucking business owner who had died in a motor vehicle accident. The largest critical illness claim was for a R5.4 million, for a 46-year-old orthopaedic surgeon who had suffered a heart attack.

These are some of the many revelations from Momentum's Claim Statistics Report for 2017.

Another important observation is that middle-aged business people constantly topped the company's death claims for the past four years, including 2017. During this time, the highest death claims were for business people who died as a result of unnatural causes, such as murder, motor vehicle and aviation accidents.

Further categories

The largest disability claim came in at R9.9 million, for a financial planner suffering from a mental disorder. And the insurer, according to his income protection benefit, is paying him an additional R93 000 a month.

Momentum Myriad Claim Statistics Largest Claims fo

The largest income disability claim was R321 000 per month, where a food and beverage business owner was suffering from a kidney disease.

Major causes

Even though the highest death claim was for an unnatural death, cardiovascular conditions and cancer continue to dominate the death claims category.

Cardiovascular conditions made up 40% of the death claims and cancer 18%. Respiratory and nervous system conditions made up 11% and 9% respectively.

Momentum Myriad Claim Statistics Major Death Claim

Critical illness claims were also dominated by conditions and illness relating to cardiovascular disease and cancer, with cancer topping the list at 38% and cardiovascular coming second at 21%.

Momentum Myriad Claim Statistics for 2017 Major Cr

Lump sum disability claims saw the nervous system being the reason for 34% of the claims, and musculoskeletal conditions second at 21%.

Momentum Myriad Claim Statistics for 2017 Major Ca

Cancer and psychiatric or mental illnesses or conditions stood at 11% and 10%.

For income disability claims, musculoskeletal conditions dominated the category at 32%. Cancer, fractures and hospitalisations, and then psychiatric or mental conditions came in at 9%, 8% and 6%.

Momentum Myriad Claim Statistics for 2017 Major Ca

The part obesity plays

During his presentation, Paddy Padayachee, Head of Claims and Risk Management, said that obesity is a major cause of death in South Africa. According to the World Health Organization, it has been tripled in the last 40 years.

"Obesity leads to coronary heart disease, cancer, diabetes, high blood pressure, and so on. According to the World Health Organization, obesity has tripled in the last 40 years.

"Being overweight can cause 13 types of cancers, and the types which stand out for me are the breast, kidney and bowel cancers.

"People must know that obesity is preventable; if there is no medical condition preventing you from attending to it, there is something one can do about it," said Padayachee.

Women versus men

For the death claims, 74% of claimants were males and 26% females. The youngest male was 21, and the youngest female 22 years old, whereas the oldest male was 104 and the oldest woman 101 years old.

Critical illness claims saw the youngest male being 21 years old and the youngest female 22. The oldest man was 78 years old and oldest woman was 75. Between males and females, males made up 64% of the claims, and women 36%.

Lump sum disability claims had a smaller age bracket where the youngest male and female were 30 and 36 years old respectively. The oldest male and female were respectively 67 and 70 years old. Male claims made up 68% of the figure, and female claims 32%.

Income disability claims were made up of 62% claims for males and 38% for females. Of these claims, the youngest male and female were 20 and 26 years old respectively, whereas the oldest male and female were 67 and 65.