Another disability claim dispute decided in favour of complainant

'Dismissive' Fedgroup Life will now pay disability and critical illness claim.

Fedgroup Life has accepted and implemented a final determination by the Long-Term Insurance Ombud to pay a disability and critical illness claim lodged by an employee benefits consultant after initially repudiating both the woman’s claim and the ombud’s provisional determination.

Read: Discovery Life loses case; is ordered to pay client over R25m Discovery Life appeals high court order to pay R25m disability claim Discovery refused leave to appeal judgment ordering it to pay ex-client R25m In the Fedgroup Life case, the complainant – who suffered from migraines with anxiety, depression, memory loss and cognitive challenges – was insured as an employee member under a group risk policy between Fedgroup Life and her employer.

Fedgroup Life stated it would review the matter with comprehensive reports from an independent neuropsychologist, psychiatrist and occupational therapist at the complainant’s cost.Her employer maintained that a critical illness claim for this should be paid as premiums were paid for July to November 2022, alternatively that a conversion option form had been submitted on 15 December 2022, which was within the 60 days of her actual termination date of 17 October 2023.

It further argued the complainant was performing her work satisfactorily as there was no evidence to the contrary and there was no excessive sick leave or medical treatment to suggest or support a disability as she was receiving study assistance and had received a salary increase in January 2022. It said the salary increase had been companywide and referred again to the agreed extension of the termination of employment date, with continued payment of premiums.

It decided the fact that there was some confusion because of two different termination dates in the termination settlement agreement could not be held against the complainant, and also did not agree that the policy definition of an eligible employee was correctly invoked in this case to argue that the complainant was not covered at the time of the diagnosis of breast cancer on 17 October 2022.

We have summarized this news so that you can read it quickly. If you are interested in the news, you can read the full text here. Read more:

Moneyweb /  🏆 5. in ZA

South Africa Latest News, South Africa Headlines

Similar News:You can also read news stories similar to this one that we have collected from other news sources.

Light a candle in celebration of loved ones | Benoni City TimesGet your tickets for Hospice’s celebration of life.
Read more »

Chippenham charity provides clean water to thousands in SenegalFountain of Life charity has created 250 boreholes to serve communities in Africa.
Read more »

BET allows fans 'Inside the life of K.O' with new reality series [watch]Reserved rapper K.O will finally show fans other sides to him with his brand new reality series set to premiere on 18 October.
Read more »

Life in prison for Soweto man who murdered his family - LNNA father of three has been sentenced for the murder of his two children and wife, as well as the attempted murder of his five-year-old.
Read more »