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|01-13-2016, 08:20 AM||#1|
Join Date: Nov 2008
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Motorcyclist denied insurance payout because he only lost one leg
Dadofthree faces losing family home because policy says loss of limbs is required
Hein Pretorius lost his right leg when he was hit by a car in August. Picture: Facebook
A MOTORCYCLIST has been denied an insurance pay-out after an accident – because he only lost one leg.
Hein Pretorius broke both legs and his pelvis when he was hit by a car on his way to work.
The 44-year-old dad-of-three was airlifted to hospital where his right leg was amputated below the knee.
But despite paying £25,000 since 1998 for life and critical illness insurance, he has been refused £120,000 compensation because of a clause requiring ‘loss of limbs’.
Contract small print clarifies that he needs to lose ‘two or more’ limbs to qualify for a payment.
Mr Pretorius, from Tunbridge Wells, Kent, has had to survive on £88-a-week in statutory sick pay and benefits since the crash in August.
He previously earned £50,000 a year in the hospitality industry and is worried he will lose the family home after falling into mortgage arrears.
He told the Times of Tunbridge Wells: ‘The insurance companies argue it is a black and white case of me signing a contract which only covers the loss of two limbs.
‘They changed their policies since then to make pay-outs for the loss of one limb, but they won’t pay out to me as my contracts were signed in 1998 and 2007.
‘It just seems like they want to wash their hands of the issue. They blame the broker for not telling me to update my policy.’
Mr Pretorius has been battling insurance firms Legal & General and Bright Grey.
He said: ‘I was previously on a relatively decent salary, but despite the help of some benefits related to my disability, my monthly income has been dramatically reduced.
‘Basically, I need to get myself physically fit as soon as possible to allow me to get back to work and earn. If I don’t, we may lose our house.’
The Financial Ombudsman ruled in favour of Legal & General in October. Mr Pretorius has advised the ombudsman he does not accept the decision and plans to present the case again
Legal & General and Bright and Grey both say the case will be reviewed at a later date to assess whether Mr Pretorius qualifies for a ‘permanent and total disability’ pay-out.
Legal & General said it was ‘bound by the terms and conditions of the critical illness policy contract which he purchased in 1999,’ adding: ‘It is too early in Mr Pretorius’ treatments and recovery to confirm if the policy definition of Permanent and Total Disability has been met.’
A spokesman for Bright Grey said: ‘It is too early in Mr Pretorius’s recovery to predict if a claim would be payable under these sections of his insurance policy, but we will review it after 26 weeks – which was the time chosen by Mr Pretorius when he took out the policy.
‘We are unable to retrospectively change our terms and conditions as it could benefit some customers and disadvantage others.’
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