In this November 2024 judgment the insured sued the insurer under a salary protection policy. The insured had attempted to take out various policies with the respondent insurer between 2015 and 2020, but her applications were declined due to the disclosure of her medical conditions. Her 2020 attempt resulted in her being asked to undergo medical assessments, but she abandoned that application. In 2021 she found a policy online, underwritten by the same insurer, the respondent. She submitted an application for cover telephonically. During that telephone call she was asked a number of personal and health related questions. Her application was successful. 

She was the victim of an attempted hijacking in 2021, and her right arm and hand were injured as a result. She alleged that her services were terminated by her employer due to the injury and submitted a claim under the policy.

The insurer rejected the claim for non-disclosure of her previous medical conditions when she took out the 2021 policy. The insured argued that the information was at the respondent’s disposal due to the fact that she had disclosed it during her previous applications. She also pointed out that the respondent approved her application for insurance (the 2020 application) despite the medical conditions she had disclosed.

The insurer argued that the unsuccessful salary protection policy was intermediated, and that the information provided on the 2020 policy was in a database that is not linked to its other database, therefore the information could not automatically be checked against her previous attempts to apply for a policy. The applicant was also informed, when she applied for the cover telephonically, that the salary cover was a new policy and that a new assessment was being done. Further, while the claim was provisionally accepted, the applicant refused to be examined by an occupational therapist appointed by the insurer. It had also come to the attention of the insurer that she was still working and therefore may not be disabled by her alleged injuries.

The court upheld the insurer’s rejection and dismissed the insured’s claim.

M.D.L v Liberty Group Limited (3387/2023) [2024] ZAECQBHC 70 (19 November 2024)