Planning financially for death remains essential. Increasingly, so too is planning for survival.
Medical advances are helping more South Africans to survive serious illnesses than before. But as more people recover physically, insurers are seeing a growing need for protection against the financial consequences that often linger long after treatment ends.
Old Mutual says its latest claims experience reflects that shift. Although overall payouts have returned to more typical levels after the Covid-19 pandemic, earlier diagnosis, better treatment, and evolving insurance products are changing the nature of claims. More people are surviving illnesses that would once have proved fatal – and increasingly needing financial support during recovery.
“What the stats are really showing us is the importance of living benefits,” says Arno Jansen van Vuuren, head of product: retail marketing at Old Mutual South Africa.
“People suffer from cancer later in life, but with medical advances a lot of people actually recover, whereas in the past they might have passed away. Now they’re sitting in a position where they’ve recovered medically, but financially they’re left in a difficult position. That’s why your severe illness and disability benefits are so important.”
Old Mutual paid R14.6 billion in claims during 2025, only marginally lower than the R14.7bn paid in 2024 and well below the R21.3bn paid at the height of the Covid-19 pandemic in 2021. On average, it paid almost R58 million every working day. Of the total, R6.8bn related to underwritten policies, R4.8bn to corporate group risk benefits, and R2.9bn to non-underwritten policies, including funeral cover.
The insurer honoured 94% of all underwritten claims during the year, including 98% of death claims and 81% of disability and severe illness claims. Since 2002, it has paid R98.3bn in claims and expects to surpass the R100bn mark next year.
For Jansen van Vuuren, the report is as much about the story behind the claims as the amount paid.
“If you almost ignore that spike of Covid, claims have gradually been growing year on year, and over the last couple of years they’ve stabilised a little. But we’re still talking about almost R15bn going into the pockets of ordinary South Africans when they need it most.
“Insurance is one of those promises that you buy when you don’t need it, but the claim happens when you really need it.”
Recovery is changing the claims landscape
Death claims remain the largest category, with Old Mutual paying R5.6bn during 2025 while maintaining a 98% payout ratio. Men accounted for 60% of claimants and women 40%, with the average claimant in both groups in their mid-sixties. The youngest successful claimants were just 23 and 21 years old, while the oldest were 98 and 101.
Yet Jansen van Vuuren believes the industry’s focus is gradually shifting beyond what happens after death to what happens after survival.
Cancer remained the leading cause of severe illness claims, accounting for 49% of all claims paid. Cardiovascular disorders followed at 29%, with central nervous system disorders contributing 12%. Together with heart attacks, strokes, and coronary artery bypass surgery, the traditional “Big Four” conditions still account for most severe illness claims.
At first glance, rising severe illness claims might suggest South Africans are becoming sicker.
Jansen van Vuuren says the opposite is often true.
“It doesn’t necessarily have to be stage four cancer to pay out anymore. It can even be stage zero in some cases. We’re definitely catching things earlier.”
He says advances in medical technology and product design have fundamentally changed what insurers see in their claims data.
“In the past, someone may have died with a cancerous tumour that was never diagnosed, and we would only have paid a death claim. Now we’re seeing severe illness claims because we’re diagnosing these conditions earlier, and eventually there may still be a death claim years later.
“In a way it’s a positive story, but it’s also still a worrying trend.”
The challenge is that survival often comes with months of treatment, rehabilitation, follow-up care, and time away from work. Those financial pressures can persist long after the immediate medical crisis has passed, and many fall outside what medical schemes and gap cover provide. As a result, the need for severe illness and disability cover is becoming increasingly important.
That changing reality is reflected in Old Mutual’s terminal illness benefit. During 2025, the insurer paid R255m to policyholders diagnosed with less than 12 months to live, with 86% of those claims relating to cancer. Unlike a traditional death benefit, the cover pays while policyholders are still alive, giving families time to focus on treatment, financial planning, and making the most of the time they have together.
Medicine has changed. So have disability claims
The same forces are reshaping disability claims.
Old Mutual paid R320m in disability claims during 2025. Men accounted for 60% of claimants and women 40%, with average claimant ages of 52 and 49 respectively. The youngest successful disability claimant was just 24 years old.
One of the more interesting findings in the report is that disability income claimants are becoming younger and increasingly male, while disability lump-sum claimants are becoming older and more likely to be female.
According to Jansen van Vuuren, the explanation lies in two parallel developments: medicine has advanced, and insurance products have evolved alongside it.
Income protection and lump-sum disability benefits serve different purposes. Income protection replaces earnings while someone is temporarily unable to work, whereas lump-sum disability cover is generally intended for permanent impairment.
“We’re seeing more things that cause people to be off work for shorter periods, and products have changed to include sickness benefits, fractures, and conditions that wouldn’t previously have been covered.
“At the same time, medical technology means people recover from conditions that once would have been considered permanently disabling. That’s why you’re seeing disability income claimants becoming younger, while permanent disability claims shift to older ages.”
He illustrates the point with one of South Africa’s fastest-growing sports.
“Padel is probably a physiotherapist’s dream,” Jansen van Vuuren laughs, “and an insurer’s nightmare.”
Someone who breaks a wrist, tears a knee ligament, or suffers another injury on court may be expected to recover fully. But if they are unable to perform the duties of their occupation for several weeks or months, they may qualify for a disability income benefit.
A decade ago, many of those claims would never have appeared in insurers’ statistics, not because people were less active, but because the products were designed differently. Today’s disability claims therefore tell two stories at once: South Africans are living differently, and insurance has evolved to protect them differently.
Lifestyle diseases continue to reshape claims
While medical advances are helping more people survive serious illness, the underlying health risks facing South Africans remain.
Jansen van Vuuren says many of the conditions driving today’s claims are linked to modern lifestyles, with obesity, smoking, poor diet, stress, and inactivity contributing to illnesses that are appearing at increasingly younger ages.
“The lifestyle diseases are growing, and the cancer claims are growing. Those are probably the two things people need to take away from the data.”
Old Mutual’s claims experience reflects that trend.
Cancer accounted for almost half (49%) of all severe illness claims during 2025, followed by cardiovascular disorders (29%) and central nervous system disorders (12%). Respiratory disorders, connective tissue disorders, musculoskeletal conditions, and sensory disorders accounted for much smaller shares. Women made up 46% of severe illness claimants and men 54%, while the youngest successful claimant was just 19 years old.
Historically, severe illness claims were dominated by the traditional “Big Four” conditions – cancer, heart attacks, strokes, and coronary artery bypass surgery. Although those conditions still account for most claims, their share is gradually declining as claims are increasingly paid for a broader range of illnesses.
Jansen van Vuuren says that reflects both advances in medicine and changes in product design. Earlier diagnosis means diseases are increasingly being detected before they reach an advanced stage, while many policies now provide benefits for earlier-stage illnesses and conditions that would not previously have triggered a claim.
A protection gap that cuts across income groups
The changing claims experience raises a broader question: are South Africans adequately insured for the risks they now face?
The latest ASISA Insurance Gap Study suggests they are not.
The study estimates South Africa’s combined life and disability insurance protection gap at R50.4 trillion. On average, income earners require about R2.1m in life cover but hold only about R800 000. The gap is even wider for disability, where the average need is approximately R3m, compared with average cover of about R1.2m.
Jansen van Vuuren says one of the biggest misconceptions is that underinsurance is mainly a problem for lower-income households.
“The interesting thing is that across earning bands, people are drastically underinsured, and less so under life cover than under living benefits. Severe illness and disability are still a massive concern.”
The ASISA findings support that view. Although higher-income earners typically hold more insurance, they also have larger financial commitments and significantly greater future earnings to protect. Younger professionals are particularly exposed because they have decades of earning potential ahead of them but generally carry relatively little protection.
Read: Affordability pressures to drive innovation as insurance gap hits R50 trillion
For Jansen van Vuuren, that underlines the need to think differently about financial risk.
Many people understand the need to provide for their families if they die. Far fewer consider the financial consequences of surviving cancer, suffering a stroke, or being unable to work for several months. Yet those are often the events that place the greatest strain on household finances.
A different conversation
For Jansen van Vuuren, the annual claims report is not simply about demonstrating how much Old Mutual paid.
Instead, he sees it as a tool to help advisers have more meaningful conversations with clients about the risks that they are likely to face.
“We don’t just publish claims statistics,” he says. “We publish them because they help advisers have meaningful conversations with clients about what people like them are actually claiming for.”
Those conversations, he says, should begin with understanding a client’s circumstances rather than recommending products.
“The change happens by having the right conversation,” he says.
To support those discussions, Old Mutual has developed an online claims tool that shows users the types of claims people with similar characteristics have made, together with the potential financial impact of those events. The tool is designed to help advisers move beyond product features and have more practical conversations about risk and appropriate levels of cover.
Jansen van Vuuren says the tool has evolved over several years in response to adviser feedback and is intended to make risk conversations more relevant at the point where financial decisions are made.
“We created the claims tool to be able to say: look at what people like you claim for, look at the things you are at risk for, look at the financial impact if these things happen to you.”
As medicine continues to advance, the challenge for advisers and consumers alike will be ensuring that financial planning keeps pace with medical progress.
As Jansen van Vuuren puts it, serious illness does not discriminate.
“These illnesses are across age, race, gender, and income levels,” he says. “When people are sufficiently protected, the legacies are in place, and their families are in a better position.”
The claims tool is available at omclaimstool.co.za.
