Sanlam’s risk products are developed on a sound basis by using our favourable claims experience to the benefit of our clients.

1. FLASH FACT March 2014
Sanlam
Pays!
Our Claims
Philosophy
Sanlam’s philosophy is to always pay valid claims.
We strive to offer clients a claims experience
which is excellent compared with the industry’s
best practices at all times. We continuously
measure ourselves against a benchmark set
according to the feedback from our reinsurers,
the Ombudsman for Long-term Insurance, and
the overall view of our clients and intermediaries.
Sanlam is the leader in South Africa in terms
of assessment practices. Our impressive track
record in the assessment of claims places us in
an ideal position to offer clients this experience.
We believe that our consistent approach to
claims management is contributing to the fair
treatment of our clients.
Sanlam’s risk products are developed on a sound
basis by using our favourable claims experience
to the benefit of our clients.
THE MAIN CAUSES OF
CLAIMS IN 2013
Accidents, poisoning and violence
Cardiovascular (heart) disease
Cancers & tumours
Other
DEATH
33%
26%
9%
32%
Cancers & tumours
Cardiovascular (heart) disease
Bones, back, joints and connective tissue
Mental Disorders
Diseases of the nervous system and sense organs
Accidents, poisoning and violence
Other
DISABILITY
16%
14%
14%
8%
10%
9%
29%
F O R I N T E R M E D I A R I E S

2. 2
FLASH FACT March 2014
HOW MANY CLAIMS WERE PAID IN 2013?
The most important reasons for declined
claims were as follows:
• The criteria for the claim were not met or
the illness claimed for was not listed in the
contract
• Non-disclosure
• Dread disease & Disability claims peaked
between ages 46 and 55. The importance
of insurance in this age group is evident.
• Because of the nature of the illnesses that
were claimed for and the claims criteria,
most of our Sickness and Income Protector
claims were paid for lives 26 – 45 years old,
and not for the middle to older age groups.
• Death claims peaked for ages 55 and older.
Cancers & tumours
Heart attack & stroke
Coronary Artery Bypass Surgery
Other
DREAD
DISEASE
58%
23%
7%
12%
Cancer
Mental Disorders
Diseases of the respiratory system
Diseases of the musculoskeletal system and
connective tissue
Accidents, poisoning and violence
Other
INCOME
PROTECTOR
6%
11%
12%
27%
29%
15%
Cancer
Infectious and parasitic diseases
Mental Disorders
Diseases of the respiratory system
Diseases of the digestive system
Diseases of the musculoskeletal system and
connective tissue
Injury, poisoning & other external sources
Pregnancy, childbirth and the puerperium
Other
SICKNESS
5%
5%
5%
13%
10%
13%
18%
7%
24%
AGE PROFILES OF CLAIMANTS IN 2013
100%
80%
60%
40%
20%
0%
Death claims
(accidental
and funeral
included)
Disability
claims
Dread
disease
claims
Income
Protector
claims
Sickness
99% 88% 80% 90% 94%
Declined Paid
60%
50%
40%
30%
20%
10%
0%
16-25 26-35 36-45 46-55 >55
Disability
Dread Disease
Income Protector
Sickness
Death
R200M
paid
R175M
paid
R2.08B
paid
F O R I N T E R M E D I A R I E S

3. 3
FLASH FACT March 2014
1 2
Real claim storiesCASE1
Mr. F had the following risk plans with Sanlam:
POLICY 1
Functional Impairment
plus Disability for regular
occupation:
R665 231
Accidental Injury:
R476 749
Mr. F and his wife were the
unfortunate victims of an armed
robbery. He was shot in the
abdomen while struggling with one
of the robbers. The bullet exited at
the T12 level of his spine, which left
him paralyzed and a paraplegic.
POLICY 2
Whole Life Comprehensive
Dread disease:
R517 500
Accidental Injury:
R1 035 000
Functional Impairment plus
Disability for regular occupation:
R517 500
Paraplegia is covered at
100% under our Disability-,
Functional Impairment-,
Accidental injury- and
Comprehensive Dread disease
benefits.
In this time of crisis Mr. F’s risk
cover at Sanlam proved to be very
valuable.
Mr. F submitted only a disability
claim under the abovementioned
plans, but we automatically also
considered a claim under the
accidental injury and dread disease
benefits on his plans.
We admitted claims under all
these benefits and an amount of
R3 211 980 was paid to Mr. F.
F O R I N T E R M E D I A R I E S

4. 4
FLASH FACT March 2014
CASE2 Dr. A was a dentist and he
took out a Sanlam risk plan
with the following benefits:
POLICY
Sickness benefit:
R150 000
(initially)
Functional Impairment
plus Disability for
regular occupation
(accelerator):
R3 000 000
(initially)
Death benefit:
R3 000 000
(initially)
In November 2010 Dr A claimed under the Sickness benefit for
corneal ectasia (sum assured = R165 375).
He underwent a corneal transplant in the right eye on 17 November
2010 and was initially booked off from 17 November 2010 to
17 January 2011. The Sickness claim was admitted for that period.
During January 2011 we received further sick certificates for the
client and he was booked off for a further period until 17 March 2011.
Dr. A was then scheduled for a permanent lens implant in May 2011,
but the implant and the treatment were, unfortunately, unsuccessful.
The Sickness claim was then paid for the full 24 months.
In January 2013 the assured submitted a claim under the
Functional Impairment and Disability for regular occupation benefit
for an amount of R3 646 519.
We referred the assured for an independent medical opinion. The
report was received at the end of April 2013. We then admitted and
paid a claim for permanent disability under this combination benefit.
The right claim
decision
Sanlam follows a
consistent, fair and
objective assessment
approach to ensure
payment of valid claims.
We pride ourselves on
applying an equitable
decision-making process
by using objective
and evidence-based
information. Each claim
will go through the same
assessment (decision-
making) process.
The provisions of the policy
contract and the medical
conditions are important
aspects to consider in
claim decisions. Qualified
medical advisers who
specialise in claims, along
with experienced claims
specialists, assess claims.
A legal adviser is consulted
in exceptional cases. Other
specialists in the fields of
psychiatry, orthopaedic
surgery and cardiology
are often consulted for
medical views, especially
when available evidence is
contradictory.
A claim will always be
reconsidered when we
receive new information.
In this appeal process the
claim will be discussed
in a claims forum. If we
repudiate a claim or when
a dispute is evident, we
refer the client to the
internal arbitrator or the
external ombudsman.
Last year more than 95% of all our Sickness claims were
paid within 3 days!
LICENSED FINANCIAL SERVICES PROVIDER
V2921 03/2014
F O R I N T E R M E D I A R I E S