ALWYAS FING EXCUSES NOT TO PAY CLAIMS

I am writing to formally lodge a complaint regarding the rejection of my second insurance claim by [Better Sure]. I purchased a home a year ago and have been diligently paying premiums towards a R4.6 million insurance cover for the property. Despite this, my recent claim has been unjustly denied, and I am seeking your assistance in resolving this matter. Background: • Property Purchase: I bought the house in [June 2024]. • Insurance Policy: I have been paying premiums for a R4.6 million cover since the purchase. • Bond: The home was financed through a bond with FNB. Prior to the bond approval, the property underwent a thorough assessment and was deemed to meet all necessary standards. Issue: My second claim has been rejected on the grounds that the home does not meet the required standards. This is perplexing and frustrating, as the property was assessed and approved by FNB before the bond was granted. If the home did not meet the standards, the bond should not have been approved in the first place. Concerns: 1. Inconsistent Assessments: The discrepancy between the initial assessment by FNB and the insurance company’s current stance is concerning. How was the bond granted if the home supposedly does not meet the standards? 2. Unjust Rejection: I have been paying premiums consistently, yet my claims are being rejected. This raises questions about the validity and reliability of the insurance cover I am paying for. 3. Financial Strain: The rejection of my claim is causing significant financial strain, as I am unable to address the issues that the insurance is supposed to cover. I have below all relevant documents, including the initial assessment report, the bond approval documents, and the correspondence with the insurance company regarding the claim rejection. I kindly request your intervention to investigate this matter and ensure that my claim is processed fairly. It is imperative that the insurance company honors the policy terms and provides the coverage I have been paying for.

Apologies for any Delays and inconveniences caused, please note we have received the damage report and it confirms that the damages are due to Substandard Workmanship and Construction Practices:

The use of inadequate construction materials has led to weak plaster and compromised the durability of the walls.

The omission of control joints has caused unregulated thermal expansion and contraction, resulting in the formation of cracks.

Structural Movement:

The pattern and nature of the cracks indicate progressive movement in the foundation and walls over an extended period.

Rising Damp:

There is clear evidence of moisture ingress from the ground, which has led to plaster delamination, surface bubbling, and other moisture-related deterioration.

Natural Aging:

The condition of the building materials and finishes suggests that some defects are due to long-term wear and material degradation over time.

The cracks are not recent and have developed gradually. They are unrelated to recent heavy rainfall events. The client has confirmed residing in the property for approximately one year and acknowledged that the issue has persisted throughout this period.

These defects—including cracking and signs of damp—are not the result of storm activity but stem from poor construction practices, non-compliance with building standards, and prolonged structural movement. The presence of mold and moisture intrusion further supports the conclusion that rising damp is the underlying cause, rather than external weather events such as storms or flooding.

Had the structure been constructed in accordance with SANS (South African National Standards) building regulations—including the proper selection of materials and installation of effective moisture barriers—these issues could have been significantly reduced or entirely avoided. Unfortunately, we are unable to honour your claim as the damages fall Defects/Poor work Manship, which is not covered by insurance.

Please be advised that we have sent the rejection proposal letter to our underwriters. Once we receive their response, we will forward it to you. If you are dissatisfied with the outcome and wish to dispute the claim, the dispute process is outlined in the letter, and you may follow the instructions provided.