Discovery Life wants to recover R16m it paid to a KwaZulu-Natal man who claimed he was permanently disabled due to depression – and unable to work – with the court ordering him last week to provide the insurance company with all relevant documents it has requested within 10 days.
IOL reports that Sunil Pranpath had taken out various policies with Discovery Life, including income protection cover in the event that he became permanently unable to work.
In June 2023, he lodged a claim after being knocked over by a car and suffering from orthopaedic injuries. The claim was accepted and the money was paid.
Eight years previously, in February 2015, he had lodged a mental and behavioural disability claim, saying that he suffered from major depression and chronic pain, which prevented him from working.
The claim was approved and paid in December 2016.
According to court papers, it was a contractual requirement for a valid claim that Pranpath must have suffered and continue to suffer a loss of the majority of his income.
As such, these claims are constantly under review, with Discovery Life requiring the insured person to periodically complete claim review forms and questionnaires.
Subsequent to the initial benefits being paid, Pranpath had completed three continuous claim forms, starting from June 2018, August 2019 and August 2020.
In all of them, he said he was totally unable to work as an accountant, was not working as an accountant, and did not foresee that he would return to work at any specified date or time.
He indicated the same in a quality of life questionnaire he completed in September 2019.
However, it was discovered that he in fact was able to work and continued to work between August 2019 and August 2020, meaning his responses to the review forms and questionnaire were misrepresentations, said Discovery.
Pranpath denied the accusations.
To prove the fraud, the insurance company conducted surveillance on Pranpath for several days in October 2019 and discovered he was again working as an accountant.
In addition, in September 2020, he refused to provide his income tax assessments and bank statements for the period 2012 to 2017, despite contractual obligations requiring him to do so.
Discovery sought relief in the KwaZulu-Natal High Court (Durban) to compel Pranpath to provide full financial information from 2012.
The documents included incorporation documents, bank statements, management accounts, financial statements (whether audited or unaudited), tax submissions, assessments and returns, records relating to payment of staff and PAYE and EMP 501 returns.
The company also wanted to know the sole proprietorship through which he trades or traded under the name of Sunil Pranpath Inc, and three corporate entitles of which he is the sole member and/or director.
In his response, Pranpath said it would be too costly for him to obtain the documents and that some of them had already been obtained under subpoena, some of the documents did not exist, and almost all the documents were not relevant for various reasons.
Discovery indicated that it did not require Pranpath to produce documents that were not in his possession, merely that he disclose their whereabouts if known. It said his complaints regarding costs were unfounded.
Acting Judge Anna Annandale was not convinced by Pranpath’s argument and said the documents were relevant to assist Discovery to make an informed decision.
“Even if certain documents ultimately turn out not to be relevant, that does not necessarily mean that the application was bad,” she said.
Pranpath was ordered to provide Discovery Life with all the documents that were requested from him within 10 days.
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