You can’t claim disability if you’re forced to stay at home

No-work-no-pay principle doesn't mean you are disabled and can no longer work

You can only claim for a disability benefit if Covid-19 leaves you disabled as defined by your policy. 

Picture: 123RF/OLIVIER LE MOAL
Picture: 123RF/OLIVIER LE MOAL

Vulnerable employees who have been forced to stay at home and are unable to work are not likely to be able to claim lost income on their group life or individual disability policies unless they meet the definition of being disabled. 

This is according to life companies some of which are concerned about an influx of claims on their policies from employees in companies that are enforcing a no-work-no-pay principle during the lockdown.

Elna van Wyk, head of group disability and underwriting at Momentum Corporate, says about 25% of employers who use its employee benefits services asked Momentum to suspend retirement fund contributions to give employers and employees financial relief during the lockdown.

Of those employers who have requested relief, more than half have put their staff on unpaid leave, she says.

Van Wyk says while many employees in the “high risk category” – people over the age of 60 years and/or with pre-existing conditions such as diabetes and hypertension – can continue to work from home and not go to work, there are many industries and professions like the mining industry, hospitals, nurses and retail workers where this isn’t an option. 

“In these cases, where the employer enforces a no-work-no-pay principle, we are seeing employees mistakenly assuming they have a disability claim,” Van Wyk says. 

However, you can only claim for a disability benefit if Covid-19 leaves you disabled as defined by your policy. 

In group life policies, disability is defined in terms of your ability to do your own or any reasonable occupation. 

Van Wyk says typically Covid-19 makes you ill for a short time and you are able to return to work within the waiting periods during which a disability benefit does not pay out. 

She says Momentum Corporate’s group insurance policies do not exclude viral infections and illnesses, which means valid death or funeral related claims due to Covid-19 will be paid, but unless you are permanently unable to work, you are not likely to be able to claim for disability. 

Reinier van Gijsen, head of pricing at Sanlam Group Risk, says Sanlam has also seen an increase of claims from employees who fall into a high risk category, especially on certain schemes, and the company is expecting more such claims. 

It has engaged with employers and funds to tell them how they will be handled. 

Van Gijsen says each of these claims will be admitted or declined depending on the specific details of each claim and the policy terms and conditions. This would include an assessment of whether the employee qualifies as disabled in terms of the definition of disability in the policy. 

Some policies include cover for temporary disability and for illness.

But Van Gijsen says simply being high risk or vulnerable to Covid-19 and being unable to work from home, does not necessarily mean that you are disabled in terms of your ability to work.

Old Mutual Corporate reports that it has not seen a material increase in queries about such claims. It also says that to qualify for a disability, you must be unable to earn an income due to a medical condition - that is you must be ill or injured, as outlined by the contract. 

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