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CR356 — Two-limb pre-existing exclusion — look-back and first twelve months
Typical South African group wording is conjunctive. The insurer needed (a) knowledge, diagnosis, treatment or symptoms of the claiming condition in the six months before entry, AND (b) disablement in the first twelve months after entry. Limb (a) was met; limb (b) was not. Symptoms in the look-back do not keep the exclusion alive once disablement falls outside the first year.
Where it is defined
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Ombud precedent
Typical South African group wording is conjunctive. The insurer needed (a) knowledge, diagnosis, treatment or symptoms of the claiming condition in the six months before entry, AND (b) disablement in the first twelve months after entry. Limb (a) was met; limb (b) was not. Symptoms in the look-back do not keep the exclusion alive once disablement falls outside the first year.