Insurer is forced to cough up for hospital stay

08 June 2017 - 09:20 By Suthentira Govender
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Image: Gallo Images/Thinkstock

The ombudsman for long-term insurance has ordered Clientele Life to compensate a policyholder whose claim for hospitalisation costs was rejected.

According to the ombudsman, the complainant's policy commenced on April 1 2015, with the waiting period ending on October 1 the same year.

"The complainant was admitted to a Margate hospital as an emergency patient on September 10 2015. He was transferred to another hospital on October 5 and stayed a total of 26 days in hospital.

"In terms of the policy conditions this was regarded as one continuous period in hospital," the office said.

Clientele Life declined the claim on the basis that the man was hospitalised during the waiting period.

The ombudsman pointed out there was no requirement in the definition of the waiting period that claims would be considered only if the date of admission to hospital was after the expiry date of the waiting period.

"As the complainant was discharged from hospital on October 8, we advised Clientele Life that we believed it should pay for eight days of hospitalisation," Judge Ron McLaren said.

Clientele Life was approached for comment, but had not responded by the time of publication.

- TMG Digital/TimesLIVE

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