Insurers turn down final plea for pay-out to accident victim

    Hein Pretorius

    father of three who was refused an insurance pay out because he only lost one leg in a road accident, not both legs, has suffered another setback.

    After being denied £120,000 worth of compensation, Hein Pretorius was hanging on to the hope that he would eventually receive compensation because of a ‘total and permanent disability’.

    He has now been informed that he will not be paid any money and is putting his apartment in Madeira Park, Tunbridge Wells on the market to move into rented accommodation.

    “The door has been shut by the insurers. They say it is a black and white case and won’t pay,” said 44-year-old Mr Pretorius.

    He told the Times that one of the main factors appeared to be the fact he has made ‘too good’ a recovery.

    “There were a couple of qualifying clauses such as being able to walk 200m [656ft] unaided or being able to carry one kilo five metres [16ft], both of which I can do.

    “This means in their eyes I have not been too badly affected by it all and so my case is dead in the water.”

    After being struck by an oncoming vehicle during his motorcycle commute to work in August, Mr Pretorius suffered two broken legs below the knee, a broken femur and broken pelvis.

    Despite having paid two insurers almost £25,000 since taking out his first policy in 1998, both Legal & General and Bright Grey, which has recently rebranded as Royal London, said the incident was ‘not critical enough’ to warrant a pay out.

    They argued he needed to lose ‘two or more limbs’ to qualify.

    Despite this, Mr Pretorius had been hopeful that since both of their policies had ambiguously stated ‘loss of limbs’ that they might have been persuaded to release the money. The liability does not fall under a motor insurer.

    His argument was bolstered by the fact that both insurers had changed their policies to include the loss of just one limb since he first signed up.

    However, it appears his options have run out, and previous fears that he may be forced to sell his home are well grounded.

    A former regional operations manager at Hush Heath Hospitality in Goudhurst, he had been on a salary of £50,000 a year.

    Because of the accident he was unable to work until this month, doing ‘general’ managerial duties part-time at the Beacon in Langton Green.

    “I started working three days a week but have moved on to four. I need to earn money. We were thinking of moving home but have had to considerably bring forward our plans.

    “We cannot afford to stay put and will move into rental accommodation. We need the money and currently do not have much of a cash fl ow and I cannot afford to retrain in a job better paid at the moment.”

    Hein Pretorius

    Mr Pretorius said he had originally planned to move out of his top floor flat and buy somewhere bigger and more suitable for his wife Ellen and children, 11-year-old Louis and seven-year-old twins Mabel and Theo.

    Mr Pretorius said he was not going to dwell on the ordeal.

    “I cannot ponder about the situation. We have done as much as we can but they [the insurers] are under no legal obligation to pay out.

    “I am gradually getting stronger and trying to get back to normality.

    “I recently got a new, better-fitting prosthetic and when I told my son Theo I was getting a ‘new leg’ he thought I meant a real one.

    “It was quite funny but also made me a bit sad. But I won’t let it eat me up and I am going to buy a lottery ticket.”

    Royal London insurance responds

    A spokesman for Royal London (formerly Bright Grey) said: “Mr Pretorius’s claim was declined as he did not meet the definition on his critical illness policy.”

    Legal & General had not responded at the time of going to print.