A KwaZulu-Natal nurse has gone to the High Court in Durban to fight Momentum Metropolitan Life’s rejection of her insurance claims, IOL reported. One of the policies was a R10 million Functional Impairment Benefit.
The mother of two wants the court to review a ruling made on September 16, 2026. In that ruling, the National Financial Ombud Scheme South Africa (NFO) Appeal Tribunal refused her leave to appeal.
Her application names Momentum, the NFO and the judge of the NFO Appeal Tribunal as respondents. She argues the tribunal made errors of law and fact and did not properly weigh the evidence.
“Momentum found other new reasons to validate why they declined the claim,” she said.
The nurse held two policies with Momentum. The Functional Impairment cover started on June 1, 2023. A Critical Illness policy started on July 1, 2023.
On July 5, 2023, she was told she was born without a left kidney. This condition is called left unilateral renal agenesis. She claimed under both policies, and Momentum declined the claims on August 7, 2023.
Momentum accepted that she had the condition. But it said the policy covered specific kidney problems, such as end-stage kidney disease or permanent dialysis. Her other kidney worked normally and she was not on dialysis.
The nurse also claimed for breathing problems. She said she inhaled toxic fumes at work on May 29, 2023. She said four lung tests showed severe restriction, with results between 40% and 50%.
Momentum said the required level of impairment had not been proven. The tribunal treated this part as a dispute over competing medical reports.
Momentum also said she did not disclose certain medical information when she applied. According to the tribunal, she answered “No” to questions about depression, stress, anxiety, breathing conditions and some medication.
The nurse said a psychologist and her treating doctors confirmed she did not suffer from depression or anxiety. She said the tribunal relied on a general practitioner who was found guilty of unprofessional conduct by the HPCSA.
She argues that dates matter in her case. She applied for the Functional Impairment cover on May 23, 2023, six days before the fumes incident. She said information that came up after she applied cannot be treated as hidden.
The tribunal found that section 59 of the Long-term Insurance Act uses an objective test. It said dishonesty is not needed for a non-disclosure to count as material.
In November 2023, Momentum offered to change the Functional Impairment policy by adding a mental health exclusion. That policy was cancelled from January 1, 2024.
The Critical Illness policy was cancelled from the start, and Momentum refunded R4,819.08 in premiums. The nurse wants Momentum to show its underwriting rules to prove what it would have done.
Momentum said it understood the nurse’s situation and had explained several times why the claims were declined.
“An independent and impartial consumer body, the National Financial Ombud Scheme South Africa (NFO), considered the matter twice and ruled in Momentum’s favour on both occasions,” the insurer said.
Momentum said it would respect the legal process and would not comment on the merits of the case. It said the court was the right place to decide the dispute.
Source: this article is based on reporting by IOL. Image: IOL. Written with the help of AI and published by the Tzaneen Voice News desk. See our Editorial Standards.
Kgomotso Maake covers news and politics for Tzaneen Voice. Kgomotso reports on government, Parliament, municipalities, courts, crime and service delivery across South Africa, with a close eye on how national decisions reach towns like Tzaneen and the wider Limpopo province. Stories are written in plain English and focus on the facts: who made the decision, what it means, and what happens next.