Benefit claims: Matrix & Legacy

Size: px

Start display at page:

Download "Benefit claims: Matrix & Legacy"

Toby Watkins
5 years ago
Views:

1 Benefit claims: Matrix & Legacy 1 January December 2017 Summary: Benefit claims Disability claims Admit % R 231,352, Decline % R 43,593, Total % R 274,946, Reasons for decline (Disability claims) Misrepresentation % R 7,830, General exclusions % R 358, Specific underwriting exclusions % R 4,524, Benefit definition not met % R 27,917, Condition not covered by benefits % R 2,962, Total % R 43,593, Accident claims Admit % R 10,233, Decline % R 50,841, Total % R 61,074, Reasons for decline (Accident claims) Misrepresentation % R 0.00 Specific underwriting exclusions % R 0.00 Benefit definition not met % R 44,607, Cover not in force % R 917, Condition not covered by benefits % R 5,316, Total % R 50,841, Trauma claims (including Child illness and Injury) Admit % R 293,328, Decline % R 152,299, Total % R 445,627, Reasons for decline (Trauma claims) Misrepresentation % R 16,612, General exclusions % R 14,671,863.10

2 Specific underwriting exclusions % R 3,456, Benefit definition not met % R 88,523, Policy lapsed % R 430, Cover not in force % R 160, Benefit doesn't exist % R 1,650, Condition not covered by benefits % R 26,794, Total % R 152,299, Income Protector Claims Admit % R 9,369, Decline % R 536, Total % R 9,906, Reasons for decline (Income Protector claims) Misrepresentation % R 70, Specific underwriting exclusions % R 169, Benefit definition not met % R 219, yet expired % R 56, Condition not covered by benefits % R 20, Total % R 536, Functional Impairment Claims Admit % R 20,075, Decline % R 59,755, Total % R 79,830, Reasons for decline (Functional Impairment claims) Misrepresentation % R 1,172, Specific underwriting exclusions % R 590, Benefit definition not met % R 51,511, Condition not covered by benefits % R 6,481, Total % R 59,755, Physical Impairment Claims Admit % R 4,426, Decline % R 15,207, Total % R 19,634, Reasons for decline (Physical Impairment claims) Misrepresentation % R 17, General exclusions % R 300, Specific underwriting exclusions % R 850, Benefit definition not met % R 12,046,065.00

3 Condition not covered by benefits % R 1,993, Total % R 15,207, Sickness Benefit Claims Admit % R 68,418, Decline % R 2,601, Total % R 71,019, Reasons for decline (Sickness Benefit claims) Misrepresentation % R 483, General exclusions % R 37, Specific underwriting exclusions % R 361, Benefit definition not met % R 1,231, yet expired % R 284, Premium position not in order % R 94, Cover not in force % R 16, Benefit doesn't exist % R 40, Condition not covered by benefits % R 52, Total % R 2,601, Accidental Disability Admit % R 20,787, Decline % R 10,861, Total % R 31,648, Reasons for decline (Accidental Disability claims) Misrepresentation % R 2,100, Specific underwriting exclusions % R 0.00 Benefit definition not met % R 6,291, Condition not covered by benefits % R 2,470, Total % R 10,861, Comprehensive and Living protector: Loss of income Admit % R 24, Decline % R 0.00 Total % R 24, Reasons for decline (Comprhensive and Living Protector : Loss of income claims) Misrepresentation 0 0% R 0.00 General exclusions 0 0% R 0.00 Specific underwriting exclusions 0 0% R 0.00 Benefit definition not met 0 0% R 0.00

4 yet expired 0 0% R 0.00 Policy lapsed 0 0% R 0.00 Premium position not in order 0 0% R 0.00 Cover not in force 0 0% R 0.00 Benefit doesn't exist 0 0% R 0.00 Condition not covered by benefits 0 0% R 0.00 Total % R 0.00 Comprehensive and Living protector: Retrenchment Admit % R 3,069, Decline % R 512, Total % R 3,582, Reasons for decline (Retrenchment) Misrepresentation % R 0.00 Specific underwriting exclusions % R 0.00 Benefit definition not met % R 197, yet expired % R 156, Premium position not in order % R 134, Condition not covered by benefits % R 24, Total % R 512,744.76

Benefit claims: Matrix & Legacy

Benefit claims: Matrix & Legacy 1 January 2017-31 May 2017 Summary: Benefit claims Disability claims Admit 157 89.20% R 114,247,482.66 Decline 19 10.80% R 10,273,325.49 Total 176 100.00% R 124,520,808.15