Are disability claims only for those with medical aids?

When was the last time you went into a government hospital? I had to ask myself that question last week as I walked through the imposing front entrance of the Victoria Hospital in Wynberg. 

For me, it was 21 years ago – the same night the British Lions beat the Springboks 25-16 at Newlands, on their 1997 tour of South Africa. The hospital was much the way I remembered it, except for the security gates which make the hospital feel like a prison, and the women in blue “scrubs” with the words “correctional services” printed in white all over them. I would be lying if I said I wasn’t intimidated.

Inside, it was a constant hive of activity: each room occupied by a patient and a nurse or doctor, while elderly and infirm day visitors waited patiently on benches outside the open doors for their turn. Two security guards questioned me about my reason for being there, and then gave me directions before turning to the next person looking to gain entry.

I went to the hospital to try to speak to a member’s treating doctor about reports that were required to assess a disability claim. The assessment process had been delayed for various reasons, and I wanted to try to get things back on track. I was not able to see the member, and the nurses were not able to confirm who her doctor was. One of the nurses on duty kindly offered to give the sealed envelope to the patient that afternoon, so that she could then give it to her doctor when she saw him the next morning. I accepted her offer with some reluctance, said thank you and sneaked a glance at her name badge before I left.

A few days later, the employer confirmed that the member got her forms that afternoon, as promised. I am, however, still waiting for any word on the reports.

Applying for a disability benefit when the claimant is being treated through a state facility is a lot more complicated than if he or she was being treated at a private facility. It is difficult to contact the doctors and emails are mostly not responded to. A cash payment of around R500 is required before a medical report will be released, which the patient often can’t afford. Often, incorrect or incomplete forms are returned to insurers, with the result that the assessment can’t be finalised. You can’t contact doctor directly, and each time you go back to a state hospital is like beginning the process all over again.

To add to the frustration, sometimes it is not possible to fulfill the insurer’s requirement of obtaining a specialist report, because the clinic the claimant has been going to for treatment is refusing to refer him to a specialist physician.

How many claims are abandoned because claimants, who are already struggling with pain and illness, feel they can no longer fight the system just to get another “current report and examination”? It may be an interesting statistic: how many claims are initiated but do not progress to final assessment stage, and how many of those involved information being requested via a state facility compared to those with medical aids who have access to private healthcare? It happens, and it is a shameful reality.

Medical aids are increasingly unaffordable, and even those who can afford them are choosing cheaper options. Lower income earners can’t afford medical aid so have to make use of state facilities. Some have cover for disability benefits through their employee benefits schemes (which they are compelled to join) however should they need to claim for a disability benefit, they are expected to provide medical evidence as though they had access to private medical care. Very rarely do the assessments take into account the waiting times at state facilities, the inaccessibility to a specialist who may also be swamped with patients, or the cost of the report which must be paid in cash, or that each time you go back to the hospital, you are treated by the doctor who is available at the time. Or does privilege extend to your ability to successfully claim from insurance as well?

We need to ask what needs to be done by insurers to make the assessment process easier for all, particularly for those whose only access to healthcare is at state facilities

Monya Kröhnert

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