Widow wins battle for disability benefit from her grave

12 December 2013 PFA

For four years Mrs M, a widow from Pietermaritzburg, struggled to receive a disability benefit from a provident fund after suffering renal failure. Sadly she did not live to enjoy the fruits of her battle.

While it is unfortunate that Mrs M (name withheld) died in 2011, her claim for what she believed she was rightfully entitled to, has been granted by the Office of the Pension Funds Adjudicator.

The equality, social justice and human rights organisation Black Sash took up the cudgels on behalf of Mrs M who had waged battle against the Contract Cleaning National Provident Fund (first respondent), NBC Fund Administration Services (Pty) Ltd (second respondent) and Supercare Services Group (Pty) Ltd (third respondent).

Mrs M was employed by the third respondent from 22 March 2003 until her services were terminated due to ill-health.

In her complaint to the Pension Funds Adjudicator Ms Muvhango Lukhaimane, she said her disability claim was repudiated due to the employer’s failure to timeously submit the necessary information to the insurer.

She said she started suffering from renal failure in October 2006 and as her health condition had deteriorated, her services were terminated in July 2007 on medical grounds. She subsequently applied for a disability benefit in September 2007, which was never paid.

She approached Black Sash to assist her in establishing what had happened to her disability claim. They were informed that the first respondent was underwritten by Momentum Group Limited ("the insurer”). They were further informed that the insurer required certain documents which were thereafter sent to the insurer and the second respondent.

Although the complainant passed away in 2011, leaving five children, two of whom were minors at the time, the Office of the Pension Funds Adjudicator continued adjudicating the complaint.

The first and second respondents submitted that the complainant’s application for a disability benefit was received in July 2007 and that further information had been sought by the insurer on 15 November 2007. The insurer’s request was forwarded to the third respondent on 25 February 2009.

They further submitted that on 22 June 2009 the insurer sent a reminder to the first respondent advising that if the information it sought had not been provided to it by 20 August 2009, it would close the file.

They submitted that as a result of the failure by the third respondent to furnish the insurer with the information it required, the insurer closed its file and the complainant’s claim was repudiated.

In her determination, Ms Lukhaimane said documentary evidence submitted by the first and second respondents showed that the third respondent was informed of the insurer’s request for information pertaining to the complainant’s disability claim. However, the third respondent failed to comply with this request.

"According to the available facts, the third respondent ought to have submitted the required information to the insurer on or before 20 August 2009.

"Therefore, by failing to submit the complainant’s disability claim documents on time, the third respondent breached a duty owed by it to the complainant.

"Had the third respondent submitted the complainant’s disability claim documents timeously, she would have been considered for a benefit.”

Ms Lukhaimane said although the complainant had since died, she ought to be placed in the position she would have been had the third respondent submitted all the required and necessary documents pertaining to her disability claim on time.

The first respondent was ordered to pay the disability benefit to the estate of the complainant plus interest.

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