The Gauteng High Court on Monday dismissed Discovery Life’s application for leave to appeal against its earlier ruling ordering the company to pay out more than R25m to a client.
The applicant in the original claim, a former stockbroker identified in the court papers as PR, is fighting for a payout for his “Capital Disability Benefit” policy, which covers him in the event of permanent disability.
His policy expired on 30 November 2015. News24 reports that in court papers, he claimed he could not work between 28 December 2014 and that date, because he had numerous health issues including “a combination of post-traumatic stress disorder and bipolar mood disorder” after his girlfriend died during their holiday in Mauritius in December 2014.
In January 2015, he was arrested and charged with her murder and detained, pending trial, before subsequently falling ill.
The company rejected his claim because it said it had no evidence he had been disabled when the policy expired.
However, Judge Stuart Wilson ruled that Discovery had no right to reject its client’s claim, saying the company should have investigated whether he had become permanently disabled before 30 November 2015.
After the High Court made its initial order last month for Discovery to pay, the company said: “The implication … is that insurers are liable to pay claims when claimants only qualify for the conditions covered under the policy a significant amount of time after the policy has lapsed.
“This could impact premiums for disability and severe illness cover, as well as the insurability of certain conditions across the industry.”
But Wilson said the company's argument that his judgment would affect the insurance industry did not hold because it pertained to Discovery and PR.
“I cannot accept that this unspecified impact on Discovery is compelling enough to ask the Supreme Court of Appeal or a full Bench of this court to entertain an appeal that otherwise lacks prospects of success.”
Discovery said it was considering its options.
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