Does FMI always pay claims?

FMI aims to pay valid claims. However, there are some instances in which claims will not be paid. The main reasons for repudiated claims include:

• Non-disclosure of information at initial underwriting stage – honesty is the best policy!
• Fraudulent claims
• Pre-existing conditions

Reasons for Claims being classified as Not Taken Up include:

• Policyholder no longer wishes to claim
• The disability is shorter than the waiting period
• Cosmetic procedures that do not meet requirements e.g. elective cosmetic surgery
• Minor infections that do not meet requirements (for certain minor infections like influenza or bronchitis you must be hospitalised, go for diagnostic testing or seek the opinion of a specialist in order to claim)
• Claims as a result of drug abuse or alcoholism
• Supporting documents not received
• Claimant not booked off work