Where the insurer has investigated and found that the condition relating to the claim was not disclosed at time of application and is considered a non-disclosure, in which case the policy may be cancelled by the insurer.
Where your medical scheme cover has lapsed or is terminated at the time of the incident, and where you are claiming for medical expense shortfalls.
When you are claiming outside the required 12 month period and/or the claim was not submitted within the 6 months of the incident and you do not sufficiently justify the lateness of submission .
Where you have not provided all the required documentation.
Where you have provided false information, in which case the policy may be cancelled by the insurer.
Where the dependent you are claiming for no longer meets the eligible spouse/dependent definition.
Where your medical scheme has rejected the claim.
Where you are claiming for a benefit that is only applicable in the case of accidental injury and you did not have an accident.
Where you are claiming for accidental injury and the ICD10 codes are not listed as accident codes.