Judge ticks off insurer for its treatment of client
WHEN Mr Chiang Soong Chee suffered a stroke, he went from a man capable of lifting drums of paint to someone resigned to signing cheques in the family-run paint store.
He was no longer able to handle his old tasks.
Never mind, he thought, he could always rely on his insurance payout.
But after making the first five instalment payments, NTUC Income held back on the remaining amount.
The insurance company, which is the biggest here with more than 1.8 million policy holders, argued that Mr Chiang was not totally and permanently disabled.
And he was able to work, though not at the same job he held previously.
Mr Chiang, disagreeing with the insurer, sued for the remaining $90,000.
And won.
SEVERELY PARALYSED
Mr Chiang became severely paralysed in his left limbs after a stroke in 1992.
He had bought a life insurance policy in 1988, which said that Income (then NTUC Co-operative Insurance Commonwealth Enterprise) was to pay $150,000 in 10 annual instalments if he became totally and permanently disabled.
But after the stroke, Mr Chiang was told by his insurance agent later that year that his disability did not meet Income's criteria.
The agent was not named in the court papers.
In March 2001, during a chat with friends, Mr Chiang was urged to go ahead and make the claim.
He decided to act on their advice and registered his claim.
By this time, after nine years of being treated by neurologist Dr Tong Hoo Ing, he was able to walk, albeit with a limp.
In August that year, Mr Chiang was examined by Dr Tong and another doctor. Both doctors certified him as totally and permanently disabled.
Initially, all went well with his claim.
The insurer accepted the doctors' findings and in Sep 2001 told Mr Chiang that it would pay him four annual instalments of $15,000 each.
The first payment was made in late 2001. A final instalment of $90,000 would be paid in 2005.
Mr Chiang was paid the first $60,000, but things then went awry.
Before Income made the final payment in Jan 2005, it asked Dr Tong to clarify Mr Chiang's current condition, which it was entitled to do under the policy.
This time, Dr Tong certified that Mr Chiang was not totally and permanently disabled, but maintained that he was unemployable.
This was because while Mr Chiang was mobile, he still carried a limp and had poor short-term memory.
Income then decided not to pay Mr Chiang the remaining $90,000, saying he was no longer totally and permanently disabled.
So Mr Chiang filed a suit.
He was awarded judgment last month in the Subordinate Courts by District Judge Lim Wee Ming, who rapped the insurer for its treatment of Mr Chiang.
The judge said the insurer could not provide a clause to attract potential customers, only to make it difficult for them to claim the money.
Said District Judge Lim: 'Income cannot on one hand have a clause that appears more acceptable to potential customers but when they seek to enforce it, Income be allowed to take advantage of the ambiguity against the customer.'
In his affidavit, Mr Chiang said that before the stroke, he handled, stacked, moved and delivered drums and tins of paint.
His lawyer argued that because of the stroke, he was no longer able to carry out such work.
As a result, his work with his family business is limited to signing cheques and bank documents.
Mr Chiang's present role in the family business was minor compared to what he was doing before, and he remained employed only out of his siblings' sympathy.
His doctors also testified that Mr Chiang was unable to do manual work.
The main issue for the court was the interpretation of the policy, which stated that the disability must be total and permanent such that the insured person is unable to earn a living.
In its defence, Income said it had observed a strict interpretation of the policy, which meant that Mr Chiang, even if only signing cheques and bank documents, was gainfully employed.
Under a broader interpretation, the court would consider work as that which the insured was doing when he bought the policy.
But Income claimed that Mr Chiang would have to show that he could not do any work whatsoever, regardless of his occupation when he bought the policy.
The judge disagreed, saying that the phrase 'regardless of the usual occupation of the Life Assured' was not mentioned in the policy.
In his judgment, Mr Lim wrote: 'Obviously, such a provision would have made the policy less palatable to potential customers.'
The judge also noted that Income's strict interpretation of the policy would then apply only to extreme cases, such as brain damage or vegetable-like existence.
And that was not fair.
He was satisfied that Mr Chiang qualified for the payout as he could not continue the work he did before the stroke.
Mr Chiang declined comment when contacted at his home, but a staff member at his family's shop, Sai Sia Paint, said he still works there.
Income's lawyer, Mr Sundararaj Palaniappan of Straits Law Practice LLC, told The New Paper that his client plans to appeal.
source:
http://newpaper.asia1.com.sg/news/st...38844,00.html? 
15 years after stroke, he wins full payout 
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