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Lump sum Disability and Impairment Benefit claim


Lump sum occupational disability benefits pay out in the event permanent disability caused by illness, injury or an accident that has resulted in the life insured not being able to perform the duties of his or her occupation.

Functional impairment cover protects you against the long term financial impact of permanent illnesses or injuries such as paraplegia, blindness and dementia. In order to approve a claim for functional impairment, we will need proof that the illness or injury has caused a permanent impairment.

Lump sum Disability and Impairment Benefit claim requirements

  • The Lump sum Disability and Functional Impairment Benefits Form completed and signed by the policyholder or duly authorised representative of the policyholder.
  • The POPIA Consent form completed and signed by the policyholder or duly authorised representative of the policyholder.
  • A copy of the life insured’s identity document.
  • Copies of all the relevant diagnostic tests or reports.
  • An up-to-date comprehensive medical report (not older than six months) from the treating specialist which must include:
    • The full clinical history and any contributing factors
    • The exact diagnosis
    • Treatment plan to date
    • Response to treatment
  • If impairment is to be assessed then the medical report must also include:
    • Whether or not maximal medical improvement (MMI) has been reached
    • If MMI is reached, a full description of any permanent functional impairment(s)
    • If MMI is not reached yet, when is it expected to be reached
    • Copies of all diagnostic tests before and after MMI
  • Proof of banking details, in the name of the policyholder (natural person or legal entity), not older than three months on a bank letterhead or that has a bank stamp it.
  • A copy of the operation report(s) (if applicable).
  • A copy of official accident report (if applicable).
  • Activities of Daily Work (ADW) claim form (will be requested by Momentum Risk Claims if needed).
  • Activities of Daily Living (ADL) claim form (will be requested by Momentum Risk Claims if needed).
  • Curator bonis appointment if the claimant is not able to handle his/her own financial affairs (if applicable)

And the following additional requirements:

If there is a cessionary

  • A copy of the authorised representative’s identity document.
  • A written instruction from the cessionary confirming the bank account to use for the claim payment as well as proof thereof not older than three months on a bank letterhead or that has a bank stamp on it.

If the claimant is a trust

  • A copy of each trustee’s identity document.
  • A copy of the letter of authority issued by the Master of the High Court.
  • A copy of the trust deed and resolution

If the claimant is a company

  • A copy of the authorised representative’s identity document.
  • A copy of the CK1 documents and resolution.

We may require additional information for medical requirements and legal entities.

Contact details to submit a Lump sum Disability and Impairment Benefit claim


lumpsumclaims@momentum.co.za

Fax: +27 12 675 3947

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