Claims-backed insights for brokers and advisers
The value of life insurance and the role that financial advisers and planners play in ensuring South Africans are appropriately insured against death, disability and critical illness events is in the spotlight again, courtesy of the 2025 Claims Statistics from Momentum Life. For 2025, the insurer paid claims totalling R6.88 billion across its retail life business, with R5.92 billion paid by the Myriad product range.
From advice to client outcomes
FAnews attended the 2025 Claims Statistics webinar, which took the familiar format of Dr Michael Mol in conversation with experts from Momentum Life. First up, Joretha Bothma, Head of Product Development, Underwriting and Claims, shone the spotlight on how valuable advice delivers exemplary client outcomes. She reminded the audience that each individual claim started with a financial adviser having the right conversation with a client, and putting the right cover in place.
Dr Mol asked whether the latest statistics contained any trends that might be useful for client-facing advisers. “Critical illness claims have reached over R1 billion rand, a more than 15% increase year-on-year,” Bothma said, commenting on higher than trend payout increases across the living benefits space. Local life insurers like to distinguish between death or mortality claims on the one hand, and living benefits, which include critical illness, income protection and lump sum disability claims, on the other.
Across South Africa, Myriad paid R3.97 billion in mortality claims in 2025, followed by R1.04 billion in critical illness claims; R602 million in lump sum disability claims; and R310 million in income protection. Noteworthy observations include that the claims experience has normalised following the disruption of the pandemic years, and that large individual claims make up a significant proportion of the totals paid in each category. The Namibian business paid N$209 million in death claims; N$18.92 million in lump sum disability; N$13.02 million in critical illness; and N$1.7 million in income protection.
Multi-year, multi-policy mega claims
Marie van Schalkwyk, Marketing Manager at Momentum Myriad, took to the virtual stage to dive into the details around death, disability and critical illness claims. The largest death claim paid out in 2025 came to R125 million, paid to a 72-year-old businessman who passed away as a result of a stroke. In Namibia, the largest mortality claim was for N$48.2 million, again paid to a businessman who, in this case, passed away following a motor vehicle accident. In each case, the total payout accrued across multiple policies.
“The R125 million claim spanned two business assurance policies and two individual policies, all put in place over a number of years,” said Van Schalkwyk. “This illustrates the value of good financial advice and the difference that thoughtful planning can make.” Financial advice professionals who work closely with their clients can structure risk protection that encompasses both family and business needs. Cardiovascular conditions (36%) and cancer (27%) accounted for the bulk of death claims, and were the leading causes across both genders.
The ‘top five’ mortality claim causes were rounded out by unnatural deaths (11%) and respiratory (10%) and nervous system (6%) conditions. “In 2025 cardiovascular conditions and cancer once again swapped places for women, with cardiovascular conditions moving back into the top spot; overall, women tend to have a high proportion of cancer-related deaths and a lower proportion of unnatural deaths compared to men,” Van Schalkwyk said. Unnatural causes account for just 6% of female death claims, compared to 14% of male deaths.
Men outpace women in unnatural death experience
“In insurance, it is widely recognised that men tend to be more comfortable with risk, while women generally have longer life expectancies,” explained Van Schalkwyk. Death is unpredictable and can occur at any time, as illustrated by the insurer’s youngest claimant, a 25-year-old female who sadly passed away due to a uterine rupture, and the oldest, a 94-year-old female who passed away as a result of multiple organ failure.
Overall unnatural deaths declined by 13% between 2024 and 2025, but accidents climbed higher, accounting for 49% of this category, followed by suicide (27%); surgery (12%); murder (10%) and other trauma (2%). The chilling ‘reveal’ from this part of the presentation was that 62% of death claims for clients under the age of 30 were due to unnatural causes, five times higher than the rate for clients 30 years and older.
In response to the age distribution for unnatural death claims, Dr Mol exclaimed: “If someone is old enough to hold a driver’s license, they are old enough to consider life insurance … life cover should become a non-negotiable conversation the moment a young person enters the workforce.” He encouraged advisers to view this statistic as an opening to engage younger consumers and make them part of the life insurance pool when they are young, healthy and still able to qualify for affordable premiums.
Terminal illness claims were discussed as a subset of death claims. Myriad can pay a death benefit while the insured life is still alive, subject to a confirmed terminal illness diagnosis; no reasonable prospect of recovery; and a medical life expectancy of less than 12 months. In 2025, the insurer paid 50 terminal illness claims, amounting to R211 million. 90% of all terminal illness claims were linked to cancer, underscoring the aggressive nature of the disease. Dr Mol emphasised the need for age-appropriate, proactive screening.
Unpacking 2025 living benefit claims
The discussion segued to living benefit claims under the critical illness and lump sum disability categories. “A critical illness often brings significant and unexpected cost; however, we continue to see a strong reliance on death cover only policies, likely driven by affordability concerns, leaving meaningful gaps in a client’s overall financial plan and protection,” Van Schalkwyk said. Myriad’s largest critical illness claim payout was R12.9 million, with the average payout ranging between R1 million and R3 million.
The stats once again showed a wide age range, with the youngest claimant being 26 years old, and the oldest an 83-year-old male who suffered a stroke. Cancer (43%) remains the leading cause, followed by cardiovascular (21%), nervous system (10%) and musculoskeletal (9%) conditions. Women tend to claim more frequently in their younger years, with most of their claims being cancer-related. Cancer claims are the leading cause of critical illness claims among men, followed by cardiovascular.
One of Myriad’s key differentiators is the breadth of cover guarantee included in its complete range. This cover pays for conditions that the insurer may not currently define, but that another insurer has introduced as a claim event. In 2025, the insurer paid 175 claims under this guarantee, totalling R33 million. “In some cases, only one other insurer covered the condition, but because at least one did, we paid too,” Van Schalkwyk said.
The disability and critical illness experience
Dr Mol introduced Nafeesa Gaida, Head of Claims at Momentum Life, to comment on the 2025 lump sum disability and income protection claims experience. The largest lump sum disability claim payout was R32.6 million to a 47-year-old male life assured.
“The client had multiple disability benefits, including two comprehensive disability benefits and two own occupation disability benefits; all of these were ancillary benefits linked to the main death cover, meaning that any payment made under these disability benefits reduces the available death benefit by the same amount,” Gaida explained. The youngest claimant was 26, the oldest 76; both women.
Under the income protection banner, the highest claim was for R5.9 million, processed under the insurer’s business protector benefit. The leading causes of income protection claims were listed as musculoskeletal (33%); cancer (13%); nervous system (12%); and psychiatric or mental (9%). A case study shared during this part of the presentation highlighted how quickly an individual’s circumstances can change, especially in physically demanding, owner-operated businesses, stressing the need for responsive cover.
Five observations to advise by
Bothma was invited back to reflect on highlights of the 2025 claims picture, making five observations that can help advisers position life cover to potential clients. First, claims are getting bigger: R100 million claims are becoming more common, and R10 million is no longer considered unusually large.
Second, health screening and proactive management of illnesses matter more than ever. Third, risk is not only age or health related; cover is needed for younger lives, while accidents, gunshots and malaria do not discriminate on age. Fourth, longevity is changing financial and risk planning needs, with the number of claims from centenarian clients on the rise, and more older people deciding to keep their cover in place. And fifth, critical illness cover is becoming essential, with the total claims paid rising faster than death claims.
The messaging to advisers was consistent throughout: advice earns its keep at claim stage. You should engage with the brand’s 2025 Claims Statistics to test your clients’ cover provider, cover types and sums insured against the evolving risk landscape.
Writer’s thoughts:
Claims statistics are useful insofar as they encourage better conversations between advisers and clients. Do you share claim examples during client discussions, and what is their major push-back when presenting comprehensive risk cover solutions? Please comment below, interact with us on X at @fanews_online or email us your thoughts [email protected].
