DISAPPOINTED CLIENT

I was admitted into hospital twice from 2nd January - 4th January 2020 and again on the 13th January - 18th January 2020 due to fever unspecified which my GP warranted hospilization. I was refered to a Physician who in turn requested further tests to be conducted to establish if there were underlying factors that could not be dectected otherwise, of which could only be determined whist hospitalized, observation and having various tests being conducted to conclude a proper diagnosis.

I am a client of AIG Insurance and I have held my hospitalization /Accidental Insurance with the company for the past 9 years. Im the breadwinner in my home and my family depends on my support financially. My wife submitted the ist claim though AIG 9 weeks ago and the second about 5 weeks ago for the hospital benefit to be paid for the duration of my stay in hospital. In between the intermittent request for documents by AIG insurance were subjected to rude and unproffesional consultants and claim handlers to name a few a Mthokozisi Mtshali who was inefficient and rude towards us. Mthokozisi Mtshali who just kept requesting documentation with no progress or action on our claim,a Pamelarinah Zondi who was persistently rude examiner in our claim, A Marilyn Lewis & Navasha Pillay who were allocated as claim examiners only to find out when documentation was sent to their emails on request that they were on leave with an automatic reply response. We were pushed from pillar to post, submitted all documentation only to have both claims rejected.

The hospital which I was admitted Life Chatsmed Garden hospital in Durban were erroneous in the coding submitted on the hospital account which was later rectified by a letter issued from the hospital explaining the error. All the detailed medical reports from the doctor, pathologists, x-rays,ultra sound reports, letter of rectification from the hospital and so forth, together with every other relevant document required was submitted to AIG Insurance. However we were informed that our claim for the hospitalization was rejected. The initial reason for rejection was the coding used by the hospital and when that was clarified, then AIG recruited an independent doctor to issue a written report indicating that I could have been treated out of hospital with oral medication. This doctor recruited by AIG did not treat me directly, neither was there interaction with my GP or Physician by this doctor before issuing this report. How exactly would this independent doctor be absolutely certain that I did not require hospitalization? Was he instructed to create such a report for the sake of rejecting my claim?

Amidst the time that AIG rendered unprofessional service to me and rejected my first claim, I had lodged a complaint against Mr Mthokozisi Mtshali & Pamelarinah Zondi.What is quiet uncanny is that one of the individuals I laid the complaint against Pamelarinah Zondi, was the person who dealt with the complaint and responded back to me. How does this company operate? Does this not clearly indicate a conflict of interest?

As opposed to relieving the burden associated with the medical insurance claims, AIG added to it,by taking forever to process my claims.,whilst repeatedly requesting documentation on a piecemeal basis. This caused extreme frustration and inconvenience to me. In addition, which is evident from the above, AIG was very persistent in trying to find loopholes to reject my claims. Unfortunately, that was the only level of persistence which was demonstrated by AIG Insurance.

They have a bunch of *********** staff on the other side of the line, who have no courtesy and regard for their clients. My claim was treated with discourtesy and my several submissions and pleas for progress were disregarded, alternatively not answered in a proper manner.

AIG Insurance like other service providers claim to be "global leaders in the insurance industry". How is this possible when incumbents within AIG are unable to render professional services to uphold the name of the organization.

Does it have to warrent the intervention from the Ombudsman for short term insurance to actually get fair and equitable /treatment from AIG Insurance? This too, whilst I have earnestly paid my medical insurance premiums for the preceding 9 years.

I have involved the Ombudsman in this matter as AIG have left me with no choice by rejecting both my legitimate claims. They have failed my trust in them, and loyalty as a good standing client for so many years.