Lump sum disability or 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 insured life 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.

If a valid claim is admitted, the claim amount will be paid to the following people in the following order:

The cessionary (if any).
The policyholder.

Lump sum disability or impairment benefit claim requirements

The lump sum disability and functional impairment benefits form (CLAIM004) completed and signed by the policy holder or authorised representative of the policy holder.
The POPIA consent form (CLAIM026) completed and signed by the policyholder or authorised representative of the policyholder.
A copy of the insured life’s identity document.
Copies of all the relevant diagnostic tests/reports .
An up to date comprehensive medical report (not older than 6 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 claimant (natural person, minor, deceased estate, legal entity), not older than 3 months on a bank letterhead or that has a bank stamp on it.
A copy of the operation report(s) (if applicable).
A copy of official accident report (if applicable.
Curator bonis appointment if the claimant is not able to handle his/her own financial affairs (if applicable).

And the following additional requirements (whichever is applicable):

If the claimant is a natural person

Verification documents (green bar-coded, smart ID card, valid driver's licence or valid passport)

If the claimant is a cessionary

Verification documents - authorised representative (Green bar-coded, smart ID card, valid driver's licence or valid passport)
A written instruction from the cessionary confirming the bank account to use for the claim payment as well as proof thereof in the form of a bank statement not older than three months on a bank letterhead or that has a bank stamp on it
Payment to a bank or cessionary claim form (CLAIM029E)

If the claimant is a trust

Verification documents - trust beneficiary (green bar-coded, smart ID card, valid driver's licence or valid passport)
Verification documents - all active trustees (green bar-coded, smart ID card, valid driver's licence or valid passport)
Verification documents - founder of the trust (green bar-coded, smart ID card, valid driver's licence or valid passport)
Trust deed or founding document
A letter from the Master's Office confirming registration of the trust

If the claimant is a private company

Verification documents of managers (Chief Executive Officer/Managing Director), (green bar-coded, smart ID cart, valid driver's licence or valid passport)
Verification documents of all directors and all shareholders with at least 25% interest (green bar-coded, smart ID cart, valid driver's licence or valid passport)
Copy of the certificate of incorporation (private company documents)
A copy of the shareholder's register or a certified copy of the organisational structure and explanation of ownership

If the claimant is a closed corporation

Verification documents of all active members (green bar-coded, smart ID card, valid driver's licence or valid passport)
Copy of the certificate of incorporation (CK documents)
A copy of the shareholder's register or a certified copy of the organisational structure and explanation of ownership

If the claimant is a partnership

Verification of identity of all partners in the partnership (green bar-coded, smart ID card, valid driver's licence or valid passport)
Verification documents of persons who exercise executive control over partnership (green bar-coded, smart ID card, valid driver's licence or valid passport)
Copy of the partnership agreement

If the claimant is a listed company

The FICA 010 checklist to be completed and signed

If the claimant is a foreign company

IDs of managers for its affairs in RSA (Chief Executive Officer/Managing Director)(valid passport, United Nations certified travel document/passport, valid travel document, refugee document (valid for 2 years only)) OR (green bar-coded, smart ID card, valid driver's licence or valid passport)
Verification documents of all directors and shareholders with at least 25% interest (valid passport, United Nations certified travel document/passport, valid travel document, refugee document (valid for 2 years only)) OR (green bar-coded, smart ID card, valid driver's licence or valid passport)
Copy of the certificate of incorporation (foreign company documents)
A copy of the shareholder's register or a certified copy of the organisational structure and explanation of ownership

If the claimant is a foreign national

Verification documents (United Nations certified travel document/passport, valid passport, valid travel document, refugee document (valid for 2 years only))
A copy of the claimant's naturalisation certificate, if born in South Africa
Written confirmation if the claimant never lived in South Africa and was not a South African resident
Form MP336 (b) (an application to the South African Reserve Bank for foreign capital allowance) completed in full and signed by the claimant who has emigrated (CLAIM013E)
Indemnity form completed by the foreign claimant (CLAIM025E)
The name of the bank and branch where the claimant banked in South Africa before departure

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

Contact details to submit a
lump sum disability and
impairment benefit claim

[email protected]

Fax: +27 12 675 3947

Learn more about Life insurance

Contact Momentum life insurance

Sales

+27 11 505 1199

[email protected]

Business hours are Monday to Friday from 08:00 to 17:00. We're closed on weekends and public holidays.

Client service and policy alterations

0860 665 432

[email protected]

Business hours are Monday to Friday from 08:00 to 17:00. We're closed on weekends and public holidays.

Claims

0860 441 111

[email protected]

[email protected]

[email protected]

Please use the applicable email address above for your relevant claim type. If you send your claim documents to the incorrect email, your claim handling could be delayed.

International number:

+27 11 505 1552

Our business hours are Monday to Friday from 08:00 to 17:00. We’re closed on weekends and public holidays.

Other Momentum contacts

Lump sum disability or impairment benefit claim