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Case Review: Insurance
Summary of some of the decisions made by the Mediators on some of the complaints received by FMB.
This summary is for information only and should not be used for other purpose.
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IMB/1877/L Temporary Disability Benefit
The assured, an insurance agent, was involved in a motor vehicle accident and suffered fractures of right femur and second metacarpal. The attending doctor has certified that the assured was unable to work from 17.2.2004 to 9.7.2004 ( 144 days ). The insurers offered to pay weekly benefit for 114 days ( 17.2.2004 to 11.6.2004 ) based on their own assessment of the nature of injuries and the assured's occupation.
In recommending the period of temporary total disability the attending doctor would have taken into account the nature of the injuries sustained by the assured and the effect of the injuries on the ability of the assured to perform his work as an insurance agent. On the last date of the consultation on 11.6.2004 the doctor reported that the assured had limited movement due to stiffness left hip and pain in the injured area. Limitation of movement would greatly affect the assured's ability to perform his work as an insurance agent.
The Mediator was inclined to believe that the attending doctor was in a better position to comment on the assured's condition as he had the benefit of personally examining the patient. Upon being queried the insurers revised their offer and paid the benefit for 144 days as recommended by the attending doctor.
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