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  • pdf CR374 - Disability
    Insurer ignoring relevant considerations concerning job description and physical nature of occupation; selectively relying on certain medical evidence while ignoring contradicting medical evidence
  • pdf CR369 - Impairment Benefit
    Physical impairment benefit; claim for permanent loss of use of ankle admitted but claim for permanent loss of use of leg declined; combination of loss of use of limbs
  • pdf CR355 - Disability [NEW]
    Claim for disability benefit on psychiatric grounds declined by insurer – insurer not attaching sufficient weight to available evidence, and misdirecting enquiry to consider chronicity of condition, not required by the policy definition (CR355)
  • pdf CR339 - Disability
    Could the complainant be considered totally disabled if she was capable of performing a part-time job only, and was she suited to the alternative occupations suggested by the Occupational Therapist? (CR339)
  • pdf CR133 - Disability - Notification of claim
    Disability - Notification of claim - Claimant's knowledge of cause of claim is prerequisite (CR133)
  • pdf CR316 - Prescription
    Prescription - Medical reports dealing only with complainant's condition many years later - prescription upheld (CR316)
  • pdf CR304 - Disability claim under credit life policy
    Disability claim under credit life policy - Complainant also member of pension fund - not disabled as defined in credit life policy, but disabled for purposes of pension fund (CR304)
  • pdf CR286 - Disability claim rejected on grounds of late submission
    Disability claim rejected on grounds of late submission - Interpretation of contract - how to determine date of disability - claim subsequently repudiated on grounds that claimant no longer a member of scheme at date of disability - application of equity (CR286)
  • pdf CR277 - Disability claim
    Disability claim - Complainant a mine shift boss suffering from epilepsy - whether capable of engaging in an alternative occupation for which he was or could reasonably be expected to become qualified - settlement (CR277)
  • pdf CR276 - Disability
    Disability - Partial permanent incapacity claim declined by insurer on the merits of the case, as also on grounds of various technical defences, being late submission of claim, non-disclosure, termination of cover, and a policy requirement that the office considered could lead to an absurdity (CR276)
  • pdf CR275 - Total temporary disability
    Total temporary disability - Whether the complainant can be considered totally temporarily disabled from performing her own occupation if her problematic reactions are triggered mainly at her workplace (CR275)
  • pdf CR259 - Disability
    Disability - Insured running a business in which he contributed 70% labour - on becoming disabled he carried on with the business, but could only do so by employing people to do the manual work - nevertheless totally and permanently disabled - failure to notify insurer of change in occupation during currency of the policy - insurer thereby prejudiced (CR259)
  • pdf CR258 - Disability - permanence of condition at issue
    Disability - permanence of condition at issue - When can a policyholder reasonably be expected to undergo surgery (CR258)
  • pdf CR240 - Disability - Assessment
    Disability - Assessment - Occupation was 30% manual - complainant still able to perform most aspects of his occupation, but could not perform any manual work as result of permanent irreversible incapacity - settlement on basis that insurer would pay 50% of capital disability benefit assured (CR240)
  • pdf CR219 - Disability claim - claimant possessed by ancestral spirit
    Disability claim - claimant possessed by ancestral spirit - Not following his own occupation - graduated as a sangoma - insurer of the view that the claimant (i) has not undergone optimal treatment and (ii) is not totally and permanently disabled as defined (CR219)
  • pdf CR218 - Disability - income benefits terminated
    Disability - income benefits terminated - Policy cancelled - insured allegedly not taking prescribed medication (CR218)
  • pdf CR217 - Disability claim under credit life policy
    Disability claim under credit life policy - Insurer relying on pre-existing condition exclusion clause - was claimant aware of or ought reasonably to have been aware of the pre-existing condition? (CR217)
  • pdf CR216 - Disability - definition of disability
    Disability - definition of disability - Housewife as an occupation (CR216)
  • pdf CR181 - Disability
    Disability cover at an advanced age (CR181)
  • pdf CR132 - Disability
    Disability - Further medical examinations - onus (CR132)
  • pdf CR78 - Interpretation of contract
    Interpretation of contract - Disability claim for permanent total disablement benefit - policy containing no definition of permanent total disablement (CR78)
  • pdf CR77 - Disability claim
    Disability claim - Repudiated on grounds that complainant capable of light physical and sedentary aspects of her employment - weight of expert evidence to the contrary (CR77)
  • pdf CR76 - Premium waiver benefit admitted and later terminated on review
    Premium waiver benefit admitted and later terminated on review - Whether cessation of benefit justified (CR76)
  • pdf CR75 - Disability premium waiver benefit
    Disability premium waiver benefit - Complainant shot in suspected hijacking - insurer insisting on annual review - not provided for in policy (CR75)
  • pdf CR74 - Disability claim
    Disability claim - Whether complainant could perform the material and substantial duties of his regular job (CR74)
  • pdf CR73 - Disability claim
    Disability claim - Insurer's reliance on specialist's medical opinion in repudiating claim - whether the weight of evidence regarding the influence of impairment on the complainant's ability to work in accordance with the requirements of the definition had been properly taken into account (CR73)
  • pdf CR72 - Disability claim
    Disability claim - Whether complainant can be considered totally disabled if he is capable of performing a part-time occupation only (CR72)
  • pdf CR71 - Disability Claim
    Disability Claim - Insurer declined on basis of alternative occupation - is the suggested alternative occupation reasonable? (CR71)
  • pdf CR70 - Disability
    Disability - Notification claim - contractual limitation of period within which insurer must be notified of "...any event which may give rise to a claim - circumstances under which it may not be reasonable for an insurer to rely on such a limitation (CR70)
  • pdf CR69 - Disability claim
    Disability claim - Claimant involved in small scale catering operation - disability payments terminated (CR69)
  • pdf CR68 - Disability
    Disability - Whether claimant qualifies for a lump sum benefit (CR68)
  • pdf CR15 - Disability
    Disability - Suitable alternative occupation (CR15)
  • pdf CR14 - Disability claim
    Disability claim - Insurer being pedantic (CR14)
  • pdf CR13 - Disability Claim
    Disability Claim - Total permanent disability (CR13)
  • pdf CR12 - Disability claim
    Disability claim - Own similar or other occupation (CR12)
  • pdf CR11 - Disability claim
    Disability claim - Claim repudiated on basis of failure - (CR11)
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