Nurse with one kidney takes Momentum to high court after rejecting her R10 million illness claim

A KwaZulu-Natal Mother has approached the High Court in Durban seeking to review a National Financial Ombud Scheme South Africa (NFO) Appeal Tribunal ruling that refused her leave to appeal after Momentum Metropolitan Life rejected her insurance claims .

The mother of two is challenging the September 16, 2026, ruling, which upheld an earlier NFO decision dismissing her complaint relating to two long-term insurance policies, including a R10 million Myriad Functional Impairment Benefit.

The application names Momentum, the National Financial Ombud Scheme South Africa and the judge of the NFO Appeal Tribunal as respondents.

The nurse argues that the appeal tribunal made material errors of law and fact, failed to properly consider relevant evidence and did not correctly apply section 59 of the Long-term Insurance Act.

The dispute centres on claims linked to the absence of her left kidney, respiratory problems following a workplace incident and alleged non-disclosure of medical information when she applied for the policies.

The nurse held two risk-benefit policies with Momentum Metropolitan Life.

The first was a Myriad Functional Impairment Benefit, with a benefit amount of R10 million, which commenced on June 1, 2023.

The second was a Complete (Enhanced) Critical Illness Benefit, which commenced on July 1, 2023.

She lodged claims under both policies after being diagnosed with left unilateral renal agenesis on July 5, 2023.

The nurse also sought cover for respiratory impairment after an injury at work on May 29, 2023, when she inhaled toxic fumes.

Momentum's position was that the missing kidney did not meet the defined events covered by the Functional Impairment Benefit.

While Momentum accepted that the nurse had left unilateral renal agenesis, meaning she was born without a left kidney, it said the policy covered specific renal conditions, such as end-stage renal disease or permanent dialysis. Her remaining kidney was functioning normally, with normal laboratory results, and she was not undergoing dialysis or other relevant treatment. The policy cover did not exclude congenital anomalies.

The critical Illness policy also did not specifically provide cover for renal agenesis in the circumstances of her claim. The NFO appeal tribunal found that the relevant section required conditions involving ongoing therapy or surgical intervention, which the evidence did not establish.

In relation to the respiratory claim, Momentum maintained that the required level of impairment had not been established.