CR185
Funeral Insurance- what constitutes ‘dependant child’- can a student undergoing motor mechanic apprenticeship be regarded as a full-time student for purposes of the policy?
Background
This complaint emanated from the Ombudsman’s television interview on 3 Talk. The complainant was one of the viewers who phoned into the programme.
The complainant’s son, a young man of 22, died in a motorbike accident. He was one of the lives assured on the complainant’s family life policy, as a dependant child.
The insurer repudiated the claim on the basis that the deceased was no longer a dependant child, because:
• he was 22 years old;
• he was not a full-time student;
• he was employed in an occupation as a “motor mechanic”- he had been employed for a year and four months and was receiving remuneration.
The complainant, on the other hand, argued that the deceased qualified as a “dependant child” because he was below the age of 23 years and was still a “full-time student”.
Discussion
The policy document defines “dependant child” as a child from two years of age up to the age of 18 years or up to 23 years where the child is a full-time student”.
However, the policy does not define “full-time student”.
We established that the deceased was an “apprentice motor mechanic”. In terms of his apprentice contract he was a learner who participated in modular training (theory) and on-the-job training (practical). During this period he worked under the supervision of a qualified journeyman, whereby all work performed would be checked by his mentor. After each level of training had been completed the apprentice would be evaluated by his mentor and tested by an accredited training centre, in order to determine his level of competence. During this time he received remuneration.
The deceased still lived at home under the care of his parents.
In the absence of the definition of “full-time student” we consulted the South African Oxford English Dictionary for some direction. A student is described as a person studying at a university or other place of higher learning as well as someone studying to enter a particular profession. “Full-time” is described as occupying the whole of the time available. We pointed out to the insurer that the phrase “full-time student” is wide enough to encompass a full-time apprentice, “apprentice” being described as “a person learning a trade from a skilled employer”. “Learning” is described as “acquiring knowledge of or skill in something through study or experience or by being taught”.
It became clear from the insurer’s response that the insurer’s intention in the policy was to target full-time students who are wholly dependant on their parents. However, the question remained whether that intention was properly conveyed in the policy.
Result
The question was never answered since the insurer, in the interests of resolving this dispute, offered the complainant an adequate ex gratia payment which the complainant duly accepted.
TS
November 2006
