CR264 Interpretation – disability cover

CR264

Interpretation – disability cover – payable only if disablement occurs while in full time employment – meaning of.

BACKGROUND

The complainant, a boilermaker, had for a considerable period of time been employed at a mine on a three month fixed-term contract which was always renewed every three months. On the last day of one of the three month periods he sustained a serious back injury while on duty. Because he was unable to carry on working his contract was therefore not renewed, and it later became apparent that as a result of the injury he had become permanently disabled from carrying on either his own or any other suitable occupation.

He held a policy in terms of which he would be entitled to two benefits. One was for temporary disability for a limited period, being monthly payments on his mortgage bond, and the other was for permanent disability, being a lump sum equal to the death benefit of the policy, in his case R230 000. Both benefits were subject, however, to a proviso that the disablement occurs while “the life insured is in full-time employment”. The issue was whether or not he had been in full-time employment at the time of his disablement.

DISCUSSION

In claiming that the complainant had not been in full time employment the insurer contended, first, that it could not be assumed that he would have been offered a renewal of his contract had he not sustained the injury, because various other considerations would have been taken into account before the employer would renew his contract. The office disagreed, because the insurer could not suggest any reason why the contract, as had consistently happened in the past, would not have been renewed had it not been for the complainant’s disablement.

Secondly, it was in any event clear, so the insurer contended, that the complainant had not been in full time employment but rather that he had been employed on a fixed-term contract of three months. A meeting of the office’s adjudicators was unanimously of the view that the term “full time employment” must be given its ordinary grammatical meaning, which connotes employment on a full day rather than a part day (part-time) basis. If the intention had been to connote employment in a permanent post, rather than a fixed-term contract, specific words to such effect could and should have been used. On a proper interpretation of the term, the complainant had therefore been in full time employment at the date of his disablement.

CONCLUSION

A provisional ruling in favour of the complainant was therefore made which the insurer accepted.

SM
January 2009

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