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We will provide a decision / answer on the claim:
A: the benefit payment will reflect in the beneficiaries account within 2 working days from the date of the letter. Beneficiaries should wait to be contacted by the employer to inform them when the decision letter was received by Group Assurance.
Disability cover is for an employee who is unable to work due to a medical condition or accident, so that they may continue to have adequate income to meet their basic needs. This benefit provides an income through the most difficult time. Disability cover aims to replace a portion of the employee’s income with either a monthly payment or a once off lump sum payment to an employee when they are totally and permanently unable to work due to an illness or injury.
Claims are assessed and managed by a team of individuals with qualifications in an allied health professions, and who are skilled in the ability to perform an occupational disability assessment. The focus of the Disability Claims team is to assess the validity of the disability claims submitted but also to assist claimants through their recovery and where appropriate through their return to work.
This is the date that the employee was no longer able to perform all of the duties of their own occupation due to being ill or becoming injured. In most cases, this is the last day that the employee was physically in the work place before becoming ill, or having an accident. It is not the date that the doctor or employer said that the member is unable to work, and it is not the date that the claim was sent to the insurer.
Sometimes employees return to work after becoming ill but then struggle to perform their duties or have frequent absences due to special medical investigations, treatment or relapses. A sick leave record and sick certificates would assist Old Mutual in determining the date of absence in these claims.
The waiting period starts immediately after the date of absence. The waiting period is the minimum period of absence from the employer’s service because of a medical condition, before a claim can be considered for assessment. Duration of waiting periods vary and is applicable to all members of the Scheme. There is no benefit payment made within the waiting period.
If additional medical information from the employee’s treating doctor is required, Old Mutual will provide the employer or employee with a request for further information which contains detailed questions to the doctor or therapist. At times the employee may need to be examined by an independent specialist or occupational therapist. In such cases details of the specialist or therapist appointment will be communicated and Old Mutual will pay for this medical information.
Once a disability income benefit is approved for payment, it is important to inform is of your nominated beneficiary and send the completed Cash4❤Ones form to us. This benefit will pay one beneficiary in the event of the claimant’s death, while receiving the benefit. This value added benefit is only for those receiving a monthly income benefit at the time of death. The benefit is payable to one elected beneficiary, should the claimant die during the payment period. For administrative purposes we have included this nomination form in the claims package. Kindly note that completion of this form is not a guarantee that the disability claim will be admitted and this should be explained carefully to the claimant.
There are two main product types of the income protection benefit – the group income protection benefit, and the temporary income protection benefit. If you are insured under a temporary income protection, the benefit can only be paid for a maximum period – which is stipulated in the policy (this can range from 6 months to 24 months). If you are insured under the group income protection scheme the benefit can be paid until a maximum of death; retirement or recovery.
It is important to understand that the benefit is only paid while the claimant is unable to work. Hence, regardless of the duration of payment stated above or in the policy, if Old Mutual are of the opinion that you can work, your benefit may be stopped. The claimant will be re-assessed periodically to determine whether they continue to qualify for the benefit. If the claimant has recovered or earns income on their own efforts, the benefit will be stopped. The disability income benefit covers the employee against the inability to work and not whether the job is available.
As from 1 March 2015, disability claimants in receipt of a benefit do not pay tax.
We believe that work is good for you. Therefore, after a period of illness or injury some claimants benefit from rehabilitation in order to facilitate their return to work.
Inform Group Assurance immediately when you intend to return to work so that your benefit can be stopped.
If we require any further medical information we will send this request to you and provide a period of 8 weeks to submit this information. If you are not able to submit within this time, please let us know.
Please inform us on the application forms of all other disability insurance products that you are covered for or have claimed for.
If we find that a claim is not valid, we will make every effort to contact you or your employer to discuss and explain our decision before we decline this claim.
Old Mutual is willing to discuss and review the outcome of your claim should you be unhappy with our decision. This process is summarized below:
1. Contact us directly:
The quickest and easiest way to query a decision is to contact us directly. Please write to Old Mutual Group Assurance within 90 days of receipt of our decision by using one of the following addresses:
You can also phone us on (021) 509 6855, or write to us at:
Old Mutual Group Assurance
PO Box 1659
2. Contact Old Mutual’s internal complaints teams:
If, after the review of our decision as indicated above, you are still not satisfied, Old Mutual provides a complaint resolution process which aims to duly address any dissatisfaction you may have with Old Mutual’s decision. You can contact the OMSTA Complaints Management Department at the following details:
Fax: (021) 504 7700
Post: OMSTA Complaints Management Department
PO Box 201