Pain is in your head, insurer tells client
Joburg woman suffering from fibromyalgia claims company spied on her
KATYJA Stewart has lost everything. Her job, her home, her car, and every cent she has saved since she started working.
She blames life insurance company Financial Management International (FMI) for leaving her and her two young daughters destitute. “They took my life away and that’s not right,” a tearful Stewart said this week.
For the past four years, the Joburg mother has been locked in legal battles with FMI over its refusal to pay her out for an income protection plan she took out with the firm in 2011.
The 39-year-old, who was diagnosed with fibromyalgia, a chronic illness, in 2015, said the firm had on four separate occasions refused to pay her out, and as of October 2017, stopped all payments to her. This resulted in Stewart being unable to receive treatment and medication required to control her illness, and her health deteriorated.
She had been paying an average of R2 000 every month to the firm.
Stewart is unable to continue work as an accountant as her illness has affected functionality in her brain and body.
She has been kicked out of her house, had to pull her children out of school, and even had to close her bank accounts. She now lives with her partner and relies on him to support them.
She claimed FMI harassed and bullied her and made her life a “living hell”.
Her problems began shortly after she submitted her doctor’s reports to the firm in 2015, confirming she had been diagnosed with fibromyalgia.
At first, it claimed there was not enough medical evidence to suggest she suffered from fibromyalgia and that she had not attempted to get better by not adhering to its pain management plan.
There is no cure.
“I was told by a pain specialist therapist they had appointed, that this illness was all in my head and there was nothing wrong. The insurance company began pulling back, saying there wasn’t enough evidence that I was sick.”
She was forced to turn to the ombudsman for long-term insurance for her policy to be reinstated. FMI settled the case and resumed benefit payments prior to the ombud delivering its ruling.
During this time, Stewart also learnt that FMI had her under surveillance. “They made it known to the ombudsman that they have proof that I was not ill as they had me under surveillance.
“The surveillance was mainly pictures of me doing everyday things – taking my children to school, going to dinner with friends, buying bread and milk from the garage, etc. FMI used these moments to insinuate I was lying about my illness.”
After FMI accused her of lying, it also accused her of misrepresenting her income on her salary slips and once again halted payment. She was also accused of forging hospital notes, and lying about her qualifications, which she said was rectified immediately with FMI.
The only discrepancy in her salary slips was that her previous employer had made irregular payments for a few months as it was going through business rescue at the time payments were made.
“A letter was written to FMI to confer this information, along with the supporting documentation pertaining to the business rescue and salary payments, showing that there is no misrepresentation made in my finances.”
Again, FMI resumed payments. Stewart said FMI also accused her of not putting any effort into getting well enough to return to work.
“I was told to write down in a diary what I’m doing every hour of every day, which I thought was absurd to begin with. They discontinued payments again because they were not satisfied with my diary entries, and they felt I was not putting any effort into getting well enough to return to work.”
In October 2017, FMI stopped payment completely. It also opened a fraud case against Stewart and recently tried having her arrested.
In the charge sheet, the firm alleged she was not sick.
“Their doctor determined that I was fit to return to work and that they have structured a new back-to-work programme after which they would be phasing out my benefit.
“My doctor wrote a letter in response that this programme would not be effective, it will only set me back. Not only will I fail, but that failure will cause further stress and retard any progress I have made, as well as jeopardise any chances of returning to work.
“My doctor suggested what I would need but FMI were not prepared to do this and stopped payment for good and have said my policy has collapsed.”
Stewart was forced to return to work, but struggled to hold on to two jobs.
“This is an insurance company that is promising the world and they have destroyed me. I just want my dignity, to raise my kids and be able to deal with the disease. They have made my disease worse.”
If FMI had not stopped payment, by 2017 she would have been fit to go back to work with the correct treatment and medication.
FMI, a division of Bidvest Life Ltd, said it had no intention of reinstating Stewart’s policy as it stopped payment within good reason.
“At no point has FMI disputed Ms Stewart’s diagnosis, and the charge of fraud opened against her by the SAPS was done in light of the fraudulent information and falsified documents pertaining to her claim,” said Brad Toerien, the chief executive.
“She was dishonest about her level of impairment. In addition, she submitted falsified employer documents, a forged hospital note, fraudulent payslips and lied about her qualification.”
Toerien said on submitting a claim in 2014, FMI began paying Stewart’s claim in good faith based on the medical information at that point.
“During this period, the FMI claims team made every effort to help Ms Stewart and facilitated numerous interventions and rehabilitation programmes to assist in her recovery. In line with our claims review process, FMI requires medical evidence validating the extent to which an injury or illness affects an individual’s ability to perform their occupational duties.
“After some time, it became clear Ms Stewart had overstated the degree of her functional impairment and the impact her diagnosis had on her ability to work.
“At this time payment was ceased, and Ms Stewart’s case was taken to the ombudsman. There was no final determination, FMI reinstated her payments until further evidence was received.
“The FMI claims team then uncovered false information and multiple fraudulent documents. FMI again stopped paying Ms Stewart’s claim in 2017.”
Stewart said in December 2018, additional specialists reports, including medico-legal reports from an industrial psychologist and occupational therapist were provided to FMI, proving her level of impairment as per their expert opinions.
“I now have the brain of a 75-yearold. We have brain scans to prove it. Who is going to cover for that?”