Discovery accused of playing “cat and mouse”
IT’S HEADING towards 11 years and a businessman claims a major insurance company is still refusing to honour the more than R2 million permanent disability claim he made.
Ravichandren (Reggie) Dhurgasamy has accused Discovery Life of playing a game of legal “cat and mouse” with him.
Dhurgasamy believes Discovery’s objective was to frustrate and deplete his limited financial resources, so that he would back down from the court action he brought against the company in 2017 regarding his repudiated claim.
The matter is back in court later this month over Discovery’s subsequent application to have Dhurgasamy’s claim dismissed.
Discovery’s application was due to be heard at the Durban High Court in November last year when they asked for the matter to be removed from the court roll, but they have since asked for its reinstatement.
Apart from two partial payouts totalling R130 050, Dhurgasamy believed Discovery’s disability cover would take full effect when he filed a claim in accordance with his policy’s “Capital Disability Benefit” in June 2011.
He anticipated accelerated capital disability and severe illness benefits, plus other add-ons as a payout.
Dhurgasamy had lower back (right sciatica) trouble and claimed it caused him permanent disability, which prevented him from working as a manager in a security business.
When he applied for the policy in 2009, he indicated that he had back surgery after an accident in 2001.
However, Discovery repudiated the claim on the basis that Dhurgasamy did not declare he received back treatment on two occasions (2006 and 2007) from a general practitioner, who diagnosed spondylosis.
The insurer viewed it to be a non-disclosure of pertinent medical information, which would have been factored into the policy they offered.
This led Dhurgasamy to the insurance ombudsman for assistance.
The ombudsman viewed the consults, based on Dhurgasamy’s explanation as isolated incidents of back pain, were not a “disorder”, his non-disclosure of the consults were not wrongful and ruled in his favour in July 2012.
Discovery responded by making payments totalling R130 050 and categorised his condition to be temporary in nature (Category C), but refused to make further payments because Dhurgasamy’s policy had lapsed in April 2012 – he claimed that he was in a dire financial position at the time.
He still believed he had a genuine permanent disability claim because he was unable to work and asked for a reassessment in August 2012.
But Discovery did not agree. Dhurgasamy alleged that Discovery then assigned investigators to monitor his movements and gather evidence to disprove his claim, which included shooting videos of his visit to the Suncoast Casino and a nightclub.
He alleged that the investigators attempted to solicit a R200000 bribe from him by saying they could get his claim approved and a money exchange was supposed to happen at his daughter’s nightclub in Umhlanga.
But the investigators did a U-turn when they realised he had alerted the police, and that they were present.
Discovery also opened a fraud charge at the Sandton SAPS, in Johannesburg, claiming Dhurgasamy’s tax submissions to SARS were improper, but the National Prosecuting Authority found that the matter did not warrant prosecution.
Dhurgasamy again requested intervention from the ombudsman and submitted various supporting pieces of correspondence, including a comprehensive medical assessment he received from an orthopaedic surgeon.
He accused Discovery of deliberately stalling the ombudsman’s processes, which dragged on for more than four years, and that they only submitted selected bits of evidence, including the videos, to uphold their stance.
In an April 2016 ruling, the ombudsman indicated that the office was unable to conclusively decide in favour of either party.
Before stating their position, the ombudsman said the onus was with Dhurgasamy to prove his entitlement to the insured benefit. While Discovery’s video evidence cast doubts on his claim, it could not be completely relied upon because it was of a poor quality, was spliced and edited.
“If Discovery genuinely believed I have no claim, why did they make two payouts previously.”
Dhurgasamy said his attorneys were ready for court action.
“All I want is my payout, but Discovery wants to play a game of cat and mouse,” he said.
Riaan van Reenen, Discovery Life’s chief executive, said: “Discovery rejects the accusation of delaying legal proceedings. The recent delay is as a result of Dhurgasamy having appointed new attorneys, who decided to oppose the exception brought by Discovery.
“This meant that the matter could not be heard on the set November 2020 date, as per the rules of Court, on the unopposed roll, solely because of the action taken by him. The matter was subsequently placed on the opposed motion roll by the registrar of the Durban High Court and is due to be heard on April 20.”
Van Reenen previously rejected all of Dhurgasamy’s allegations and stated that the insurer’s investigations were conducted in accordance with the law and in a fair manner.