The policyholder had paid all his monthly premiums as at the date of the heart attack.
- The policy provides that the “benefit”, as specified in the schedule, shall be payable if the policyholder suffers one of the events or conditions described in the policy.
- The benefit amount at the time the claim was instituted – had no claims been made prior to that claim – was R2 315 250.
- Hollard claimed the benefit amount is static and, upon each claim being submitted under a particular Benefit Group, the balance reduces.
- Judge Opperman said it is clear from reading the policy as a whole that the percentages shown for each event within a Benefit Group, is payable “per cardiovascular event”.
- Judge Opperman said she is persuaded by the wording of the policy and the evidence, or lack of evidence presented in the trial, and therefore concludes that the amount payable for the heart attack suffered by the policyholder –and claimed for on 15 August 2015 as Event 3 – entitles the policyholder to payment of 100% of the benefit amount as at that date.
- The benefit amount was R2 315 250, of which 25% or R578 787.50 had been received by the policyholder.
- In addition to paying the policyholder the R1 736 437.50 balance of the benefit amount in the policy, Judge Opperman ruled that Hollard must:
- Pay interest on this amount at the rate of 10.25% per annum from 23 May 2018 to date of final payment;
- Pay the costs of the court case; and
- Remove certain specified documents from Caselines, an electronic court case management system, within 24 hours of her order being mailed to the attorney of Hollard’s client who brought the application.