Asked by DianeE on 30-06-2015 11:29:53
Question posted in the Consumer Protection Law category relating to Gauteng
Question posted in the Consumer Protection Law category relating to Gauteng
My fiance belonged to an Employer owned Group Risk Life disability insurance policy via his employer. Money was deducted each month from his salary. Benefit statements were received from The Pension Fund and not from the holder of the Disability Policy. We were never able to submit a disability claim because the Employer would not disclose who the insurer was. The ombudsmans has ruled in favour of the insurer for a late claim submission.
The disability insurance did not form part of his employment contract, his employment contract only states belonging to Pension Fund.
Under the CPA did he not have a right for the insurer to disclose who they were and to offer benefit statements and the T&C's of their contract i.e. we had 90 days to take out another policy after dismissal from the company for ill health.
So I would like to know if there is anything we can do to hold the Insurer liable for not disclosing who they were under the CPA.
The disability insurance did not form part of his employment contract, his employment contract only states belonging to Pension Fund.
Under the CPA did he not have a right for the insurer to disclose who they were and to offer benefit statements and the T&C's of their contract i.e. we had 90 days to take out another policy after dismissal from the company for ill health.
So I would like to know if there is anything we can do to hold the Insurer liable for not disclosing who they were under the CPA.
Message from the Lawyer
Posted by Att. Patrick on 01-07-2015 13:23:59
Hi there and thank you for your question,
Typically the employer would have taken out the disability cover with the insurance company on your behalf, and the insurance company would sent your employer all of the contracts, invoices, monthly statements, terms and conditions, etc.
If you're asking whether, in terms of the CPA the insurance company was obliged to send you (as the consumer) a copy of those documents, then my answer is as follows:
Yes, you have the right in terms of legisalation (including the CPA) to request copies of those documents from the insurance company, but you need to have first made the request.
As far as the insurance company is aware, them sending those documents to the employer would be enough. How would the insurance company know that the employer is not providing the documents to the employee? They wouldn't.
To have any chance at succeeding, I would suggest that you would need to prove that you requested the relevant documents from the insurance company, and notwithstanding your request the insurance company refused to hand the documents over.
No, proceeding against the insurance company is not the best way. In my opinion.
What about suing the employer? Essentially the employer's refusal to hand over the information caused your fiance to suffer a financial loss in that he couldn't claim against the insurance company in time. That means that the employer's conduct caused the loss. Unless the employer has a legally valid reason for not handing over the information pertaining to the insurance company, their actions would be wrongful.
My advice would be to go after the employer.
If there is a part of the answer which you need more advice on, or clarity please continue in this same thread instead of opening a new question.
Att. Patrick
Please remember this is a dialog if you have follow up questions please use the REPLY button and ask. If I did not answer the question you thought you were asking, please respond with the specific question you wanted answered. I hope you found my answer helpful, and you have finished asking your questions, please click on the GREEN ACCEPT button in order to mark the question as closed.
Typically the employer would have taken out the disability cover with the insurance company on your behalf, and the insurance company would sent your employer all of the contracts, invoices, monthly statements, terms and conditions, etc.
If you're asking whether, in terms of the CPA the insurance company was obliged to send you (as the consumer) a copy of those documents, then my answer is as follows:
Yes, you have the right in terms of legisalation (including the CPA) to request copies of those documents from the insurance company, but you need to have first made the request.
As far as the insurance company is aware, them sending those documents to the employer would be enough. How would the insurance company know that the employer is not providing the documents to the employee? They wouldn't.
To have any chance at succeeding, I would suggest that you would need to prove that you requested the relevant documents from the insurance company, and notwithstanding your request the insurance company refused to hand the documents over.
No, proceeding against the insurance company is not the best way. In my opinion.
What about suing the employer? Essentially the employer's refusal to hand over the information caused your fiance to suffer a financial loss in that he couldn't claim against the insurance company in time. That means that the employer's conduct caused the loss. Unless the employer has a legally valid reason for not handing over the information pertaining to the insurance company, their actions would be wrongful.
My advice would be to go after the employer.
If there is a part of the answer which you need more advice on, or clarity please continue in this same thread instead of opening a new question.
Att. Patrick
Please remember this is a dialog if you have follow up questions please use the REPLY button and ask. If I did not answer the question you thought you were asking, please respond with the specific question you wanted answered. I hope you found my answer helpful, and you have finished asking your questions, please click on the GREEN ACCEPT button in order to mark the question as closed.
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