Call: 0860 103 236

For up to date information about the pandemic visit www.sacoronavirus.co.za

Please select an appropriate category from the list below or search for topics and cases using the search tool. Please type in the "CR" prefix when searching by case codes.

Sub Categories

CR374 Disability

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 Background 1. The complainant, a farm manager, injured his right leg, knee and ankle in a tractor accident in 2012 (the tractor drove over his leg). After surgery and rehabilitation […]

Read More

CR368 Disability

CR368 Disability Introduction This case concerns the termination of the payment of a monthly disability income benefit which had been in payment for just over a year, after the insurer had discovered, through the use of electronic surveillance by forensic investigators, that the life insured was actively involved in the running of two businesses: a […]

Read More

CR365 Pre-existing conditions Disability benefit claim

CR365 Pre-existing conditions Disability benefit claim; pre-existing conditions clause does not cover complainant’s condition Background: 1. The complainant had two policies, being a Personal Loan Protection Plan and a Credit Card Protection Plan, both these policies covering, inter alia, permanent disability. 2. The complainant was diagnosed with gout and arthritis a few weeks prior to […]

Read More

CR363 Disability claim Reasonableness of alternative occupation

CR363 Disability claim Reasonableness of alternative occupation The applicable definition of “Occupationally Disabled” read thus: “The Life Covered is Occupationally Disabled if he or she is unable, due to illness or injury, to perform the duties of any occupation which the Life Covered could reasonably be expected to follow, taking into account his or her […]

Read More

CR362 Waiting period / Disability / Equity

CR362 Waiting period / Disability / Equity Unusual 24 month waiting period for permanent disability; equity invoked Background 1. The life insured had an accidental death and permanent total disablement policy. He was involved in a motor vehicle accident in March 2015 and suffered head injuries and a consequent stroke. The medical evidence indicated that […]

Read More

CR355 Disability Claim for disability benefit on psychiatric grounds declined by insurer

CR355 Disability 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 Background 1. The complainant worked as a general manager for a car dealership. His duties included managing financial returns, staff […]

Read More

CR343 Equity Disability claim declined; complaint lodged eight years later

CR343 Equity Disability claim declined; complaint lodged eight years later; insurer defending on basis of prescription; whether our office could come to complainant’s assistance on grounds of equity. Background 1. The complainant, a member of the SAPS, submitted a claim on 29 January 2002 for the disability cash benefit (R30 000) on his universal policy. […]

Read More

CR339 Disability Could the complainant be considered totally disabled if she was capable of performing a part-time job only

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? Background 1. The complainant was employed as an Estate Agent (Manager) from 2005 until she was diagnosed with SLE (Systemic Lupus Erythematosis) in […]

Read More

CR316 Prescription – Disability claim lodged 9 years late

Prescription CR316 Disability claim lodged 9 years late – no up-to-date medical reports – prescription upheld. During August 2001 the complainant had applied for and been granted a State disability pension after suffering a stroke, which had been precipitated by hypertension and a mild stroke. He was the holder of a life policy but had […]

Read More

CR316 Disability- Prescription – medical reports dealing only with complainant’s condition many years later

Disability CR316 Prescription – medical reports dealing only with complainant’s condition many years later – prescription upheld. During August 2001 the complainant had applied for and been granted a State disability pension after suffering a stroke, which had been precipitated by hypertension and a mild stroke. He was the holder of a life policy but […]

Read More

Subscribe to our Newsletter