Sentrix Digital · ClaimBuddy · South Africa
The compiler for an income-protection claim file
Insurers rarely kill a valid claim on the medicine. They kill it on language and missing paper. “Illness” is treated as if it were incapacity. The specialist letter exists — just not in the file. The internal review clock has already started.
This tool compiles an unsorted dump into a file an assessor can actually read: chronology, conflicts, duty-impact, policy tests found in this wording, gaps with named holders, a deadline clock, and draft letters you approve. South African files route complaints through insurer internal review, then the NFO.
No dump yet?
Start from the profile — stage, parties, occupation, health story, salary, dates. You can drop documents into the same file afterwards. Same File, same pack.
The old 8-step wizard is now the profile editor, not the front door.
ClaimBuddy is for
Group income protection · Individual income protection · Disability and TPD · Cover inside super
Language
Four lanes, not synonyms
Everyday talk, medical labels, functional limitation, and policy tests are different vocabularies. Mixing them is how a valid claim is argued as if it failed a test it never sat.
Paper
Who holds the record
Gaps name the holder — employer, insurer, hospital, specialist — and draft the request. You send it.
Also tracked
Date of Absence
Symptom onset, first sick note, your date, the insurer’s date, and notice are rarely the same day. The compiler keeps both sides and flags the conflict rather than averaging it away.
Bring what you have
Unsorted PDFs, Word, emails, images. Or start a profile if the dump is not ready. Classification is a guess you correct.
The File
Parties, chronology, the argument (illness → function → duties), policy tests in this wording, missing paper, clock.
Pack and letters
Numbered export plus drafts: employer, insurer, internal review. Not advice. You approve every line.
Audience
Who this is for
Choose a role — see what this is worth to you.
Language the file has to keep apart
ClaimGuard’s language map lives in this compiler. These three pairs sink otherwise-valid claims.
Do not mix
Illness ≠ Incapacity
You can be ill before policy incapacity begins — dates matter.
You can feel ill before policy incapacity begins — capture when duties became impossible, not just first symptoms.
Do not mix
Diagnosis ≠ Disability
A serious diagnosis does not automatically win; a modest diagnosis can still support disability if duties are impossible.
A label on a form is not the claim — pair every diagnosis with duty impact evidence.
Do not mix
Symptom ≠ Functional limitation
Insurers need the second. Symptoms are the raw material.
Translate each symptom into a material duty it blocks — that is what insurers argue about.
Traps the File watches
Stage-aware. They also fire as warnings on an open file, not only as a list in the library.
- Diagnosis trap — A diagnosis label alone does not prove you cannot perform material duties.
- Job-title trap — Job title may understate workload, pressure, travel, supervision, and error consequences.
- Date trap — DOA, notice, submission, complete claim, waiting period, and rejection dates are rarely the same day.
- Threshold-shift trap — The standard at submission may be broader than the standard applied at rejection.
- Policy-vs-guide trap — HR emails and claim guides may use broader language than binding policy wording.
- Employer-record trap — Payroll, absence records, and employer statements may be decisive but sit with HR — not you.
- Specialist-evidence trap — Missing specialist evidence is unsafe if you were never told what, why, who obtains it, or who pays.
- Gross-benefit trap — Benefit % is not final until earnings definition, caps, offsets, and tax are checked.
- Pre-existing trap — An old diagnosis is not the same as proving a pre-existing exclusion under your policy dates.
- Appeal-story trap — Emotional narrative should become a structured issue matrix with evidence and remedies.
- Mitigated-state trap — Discrimination law often tests function WITHOUT treatment or aids; income-protection policies usually test WITH ongoing treatment. Mixing those tests is how a claim is argued as if the person is 'fine on meds'.
Where a ZA file sits
- Symptoms begin — Health changes; work still attempted or reduced.
- Work impact — Material duties start to fail — often the true Date of Absence.
- Notice — Employer and/or insurer notified. Not the same as a complete claim.
- Waiting period — Continuous incapacity must run; breaks can reset the clock.
- Assessment — Insurer applies the policy test to the file they hold.
- Rejection — Grounds stated — often dates, duties, or missing specialist evidence.
- Internal review — Issue-by-issue response with a cure plan.
- Ombud complaint — External complaint via NFO.
- POPIA access — POPIA and PAIA.
South Africa: POPIA and PAIA. After internal review, NFO complaint after internal review. Clinicians: HPCSA. Occupations: ESCO (SA overlay). Workflow detail →
Open a file
No files yet. Drop documents or start a profile.
Library — the same tool
Directory, glossary, and cross-links. The compiler uses these as lookups on The File. They are not a second product.
Language map
20 terms · four lanes · confusion pairs.
LanguagePolicy traps
11+ named failure modes, stage-aware on the File.
LanguageGlossary
Policy terms, doctor-test questions, readiness — every entry cross-linked.
PaperEvidence gaps
Who holds the record, why it sinks a valid claim.
Directory · ZAClinical Atlas
Conditions, medications, clinicians — linked to schemes and language terms.
Directory · ZASchemeBook
CMS schemes, PMB, CDL, DTP — plus the jargon guide, standalone.
LibraryFull library
Everything ClaimGuard used to keep on its own hub, under this compiler.