CR316 Prescription – Disability claim lodged 9 years late
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 been unaware at that time, because it had been ceded to a bank as security for a loan, that the policy also provided disability cover. He had therefore not lodged any claim with the insurer at that stage.
The benefit ceased on 1 September 2001, but in February 2010, after the loan had been settled and the cession cancelled, the occupational disability cover came to his attention. He immediately lodged a claim with the insurer for the disability benefit, and in support of it he submitted a medical report which had been compiled after a medical examination conducted during November 2009. In the report the doctor recorded the complainant’s then current ailments (chronic backache with pain radiating to the legs, weakness on left side of the face and poor vision in the left eye), as well as what the complainant told him of the hypertension and mild stroke that had led to the approval in August 2001 of his State disability benefit application. No medical or specialists’ reports were submitted confirming an examination during August 2001 and what his medical condition was at the time or at any relevant stage thereafter.
The insurer repudiated the claim on the grounds of prescription.
We found that as there was no medical evidence setting out what his condition had been during August 2001, or which set out the basis for the State certifying him as disabled at the time, the insurer’s repudiation of the claim was justified. We found further that even if there had been evidence setting out the basis for the State granting the disability pension, it would not necessarily have shown that the policy definition of disability had been met at that time. In the circumstances we upheld the insurer’s defense of prescription.