A niece of mine who suffers from spina bifida has been declared by her specialist unfit to go back to work because of chronic acute diarrhoea. Her employer has applied to their insurers, Alexander Forbes, for a disability grant, but this has been refused. She intends to appeal, but she has been told that unless she goes back to work on Monday she will not receive any payments from either her employers or AF. What can she do? She needs an ombudsman.
Good day. This is an info request to assist you better. Please continue on this thread.Does she have any sick leave due to her?
No, I don't think so. She has been in and out of hospital for several months, and her employer has been paying her. Her physician has said in her report that she has reached a stage where the diarrhoea is not responding to treatment because her general condition is deteriorating. She would very much like to return to work, but it is extremely embarrassing to be constantly caught out by completely unexpected waves of diarrhoea. As I expect you know, spina bifidas have no feeling in their lower limbs, so they have little defence against accidents of this kind. She already has everything that incontinence pads and drugs can do for her, but it is not sufficient.
Are you asking for advice on the conduct of the employer or the insurer?
I think the employer has behaved impeccably. the problem lies with the insurer, who clearly thinks she is simply exaggerating her condition. (Why don't they send independent assessors to see the person concerned?) She is appealing the decision not to allow her a disability grant, but there doesn't seem to be any reason to justify their changing their minds if no new information is forthcoming.
Unfortunately, before she can take the matter to the Ombudsman, they are going to require from her to follow the full appeal procedure. They will not look at the matter unless she has done everything that is required in terms of the policy documents at the insurer and they have shot her off there. The relevant ombudsman should the the Ombud for Short Term Insurance, which you can find at www.osti.co.za.In the meantime, she could contact the Department of Labour to establish whether she can claim UIF on illness benefits.
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L.LB, Civil and criminal litigation, contracts, labour and family law
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