On 26 September 2024, the high court dismissed an application to obtain benefits from a group life policy with a Global Education Protection benefit.
The applicant, acting in her representative capacity of her minor daughter, attempted to claim benefits under a group life policy issued by the insurer. The policy provided indemnity cover for education of children following the death of a member of the scheme.
Legal right to sue
The insurer submitted that applicant did not have legal standing to claim because there was no contract between the applicant and the insurer. The group life policy was concluded between the insurer and the deceased’s employer. Benefits under the policy were payable to the employer.
The policy clearly indicated that the deceased was a member of the employer’s scheme and was not a party to the underlying agreement between the insurer and his employer.
The court held that the applicant could not claim directly from the insurer and she did not have the requisite right to sue.
Eligibility for benefits
Despite its finding on legal standing, the court dealt with the merits of the claim.
The policy placed the burden of proving eligibility for the Global Education Protector benefits on the employer. The employer, who was not party to the proceedings, relied on the applicant or the deceased’s family members to secure and submit proof the deceased was the minor’s biological father.
The insurer had the right to determine what information was considered proof of eligibility. The insurer required an unabridged birth certificate and proof of payment of the minor’s school fees for 12 months prior to the deceased’s death. The court emphasised that the insurer was entitled to stipulate its contractual preconditions for payment.
The court acknowledged the applicant’s challenges in obtaining the required documentation. The affidavits by the deceased’s siblings did not pass muster and there was no proof that the deceased paid for the minor’s education or contributed to her maintenance.
The court dismissed the application.
The case demonstrates the issues associated with claiming benefits under group life policies, particularly when proving eligibility and establishing a contract.
C.M.M v Discovery Life (2023-013519) 2024 ZAGPPHC 989 (26 September 2024)