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Appealing Insurance Disability Claims in South Africa

Insurance disability claims refer to the process whereby a person appeals the decision from an insurance company not to pay out on a claim for disability. People buy disability insurance policies to ensure that in the instance where they are injured in sport, at work or during a leisure activity or become disabled because of disease that they would still get an income.

Policies differ on the pay-outs. Many insurers pay out lump sums whereas others provide payments over a period. Irrespective of the payment method, insurance companies often deny insurance disability claims on technical grounds even if the person paid their monthly premiums on time over a long period.

The policy holder then faces the challenge of opposing the insurance company to receive the pay-out. Without the help of an attorney specialising in personal injury, civil claims and insurance disability claims, the policy holder may find it difficult to get any form of cooperation.

The disability may be so severe that the person is unable to perform their normal work or business duties and the situation can thus lead to loss of income. Add to such, the burden placed on family members to care for the person and the medical costs associated with the condition and it becomes clear that the refusal to pay out on a disability claim can financially ruin the policy holder and even prevent the person from being able to afford proper medical care.

In many instances the insurance companies are reasonable in denying insurance disability claims, but there are instances where the insurer is in the wrong and then it is imperative to take the necessary legal action to get proper compensation.

For such, it is essential to study the policy in detail and to have a medical professional review the policy holder’s condition. The policy holder should get a copy of their medical record and seek legal guidance from a medical law attorney.

Important Steps

  1. Obtain a copy of the policy.
  2. Review the details and terms & conditions of the policy.
  3. Review the insurer’s letter in which they reject the claim.
  4. Tick off deadline dates for replying and appealing on a calendar and be sure to stick to those dates.

Where possible, seek legal guidance when filing the initial insurance disability claim even before receiving a letter of denial. The attorney will assess the policy and help you complete the claim in the correct manner and ensure that you have the supporting documents when filing the claim. If, however, you have already received the denial letter don’t attempt to take on the insurer without legal help.  Many insurance companies consider your appeal more seriously when you have an attorney representing you.

It is important to gain as much as possible evidence in support of your appeal. The attorney will be able to assist in requesting medical records and to submit such. If the claim was rejected because of a lack of evidence, you may need to undergo further tests such as x-rays or blood tests to confirm the diagnosis of the medical professional. Where needed, the attorney will obtain supportive evidence such as written testimonies from colleagues or family members regarding your condition.

Contact Adele van der Walt Incorporated to get expert legal assistance in submitting or appealing the outcome of your insurance disability claim.


Note that the information in this article is for information purposes only and should not be seen as an attempt to provide legal advice. We strongly recommend that you contact us at Adele van der Walt Incorporated for professional legal advice.

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