Discovery Life has been ordered by a court to pay more than R25 million to a man who had become ‘totally and permanently unable’ to work due to a series of ‘deeply traumatic events’.
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The man, referred to as PR in court documents, claimed that he was unable to fulfill his work duties between 28 December 2014 and 30 November 2015, due to a combination of post-traumatic stress disorder and unspecified bipolar mood disorder.
PR underwent psychotherapy, occupational therapy and various drug treatments but was deemed to never be able to recover from his condition.
Discovery Life repudiated his claim because his insurance cover expired on November 30, 2015, and there was no evidence that he had become totally and permanently unable to perform as a stockbroker by that date.
During the court hearing, Discovery’s legal representative argued that the question was whether the repudiation was reasonable based on the information that PR had provided to Discovery when he submitted his claim.
According to a ruling by Judge Stuart Wilson of the Gauteng High Court in Johannesburg, PR was a successful stockbroker who had taken out an insurance policy worth a monthly premium of about R20 000.
The policy was seen as an indication of his success in his demanding job. His treating psychiatrist and occupational therapist testified that his work required a resilient personality and good judgement.
As a stockbroker, his job was to invest his clients’ funds and buy and sell financial assets in a way that would maximise their returns. His therapist stated that the job was high-stakes and high-pressure and required good social skills to handle deals.
Despite the high financial rewards from his job, including being able to buy a villa in Mauritius, things took a turn for the worst on 28 December 2014 when PR’s girlfriend drowned in a swimming pool while they were on holiday at the villa.
According to court papers, PR found his girlfriend floating in a swimming pool and was unable to resuscitate her.
In January 2015, he was arrested, charged with her murder and detained pending trial. The stress of the situation led to a breakdown and he was admitted to the secure ward of a local hospital for four days.
A state psychiatrist assessed him and found that he was psychologically distressed and suffering from depressive illness.
Over the following months, PR’s condition worsened, and he lost a significant amount of weight. By December 2015, he was unable to provide a logical narrative account of his experiences and was diagnosed with post-traumatic stress disorder and major depression.
His legal representative requested a medical evaluation to determine if he was fit to stand trial, and his mental state continued to deteriorate during the evaluation.
The court ultimately found that PR was ‘totally and permanently unable’ to work as a stockbroker and ordered Discovery Life to pay him over R25 million.
Judge Stuart Wilson of the Gauteng High Court in Johannesburg ruled in favour of PR’s legal battle against Discovery Life Limited.
The case centred on PR’s insurance policy, which he had taken out before he was charged with his girlfriend’s murder while on holiday in Mauritius in December 2014. The insurance policy covered PR in the event of being unable to work due to incapacitation.
PR claimed that he suffered from a post-traumatic stress disorder and major depression as a result of his girlfriend’s death and was therefore unable to continue working as a stockbroker.
The judge found that PR was indeed incapacitated on or before 30 November 2015 and that the care and treatment that might have rehabilitated him had been exhausted.
Wilson ruled that Discovery was liable under the policy as of that date and had a duty to pay out by 1 May 2019, at the very latest, when it became clear that PR’s incapacity was permanent. Wilson stated that Discovery had not acted reasonably when it rejected PR’s claim in August 2016, vacillating between the proposition that PR’s policy had expired and that it had not been established that his incapacity had become permanent.
Wilson found that Discovery was under a duty to establish whether PR had suffered a permanent incapacity on or before 30 November 2015, as it was this event that triggered its liability under the policy.
The judge found Discovery liable under the policy and ordered the company to pay PR what is due to him.
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