1 reviews | Active since May 2018
Chubb Insurance Claim
Hi There
Could i please get help on my below query i have asked many people and did research on many platforms and i just cant seem to get any joy or even a second look at this problem. My two sons health is very important to me and i feel that Chubb Insurance are just not taking me serious at all. Please see below:
I had a sports policy for both my sons since 2013 which was called Kestrel before and we paid in advance annually.
When I approached them in 2016 to renew my policy they informed me that they now take a monthly premium which I accepted. I then completed the forms and send back to them. They in turn send me the policy docs and the premiums were deducted ever since.
In February 2018 I enquired about a claim for my son as he injured his knee in April 2017 and he only had an operation in 2018 after continuous consultations with Physio the******, an MRI scan done at Groote Schuur hospital which was eventually and luckily paid by the medical aid, but an operation was never going to be performed unless they were 100% sure and besides that our medical aid was depleted and we had to wait for the medical to kick in again for 2018 before we could go for another opinion as the knee didn’t heal.
The specialist then advised that he have an operation on 9 March 2018 and the bill combined came to R25K and the medical aid paid R15K which left us with a bill of R10K. I only send in the claim for R7K. (All invoices is herewith attached with correct amounts).
I received the claim form from Jolene in February 2018 and then I called to follow up then they said the policy was cancelled and the claim rejected. This was their first response to me as below:
“Dear Mrs Gaffoor
Claim number: ********** 578
Kindly be advised that the claim for Mr GA Gafoor has been reviewed and we regret that we are unable to settle the claim due to the fact that the date of incident was 22 April 2017 and the claim was submitted to us on 2 May 2018 which is more than a year later.
May we refer you to the policy wording:
“Notification of Claims
1. In the event of any occurrence likely to give rise to a claim under this Policy, the Policyholder shall provide written notice of such Event to the Binder Holder as soon as reasonably possible after the date of the occurrence but no later than 30-Days of the Event. All claims must be notified to the Insurer(s) no later than 60-Days of the event by the Binder Holder. “
Furthermore, the policy was cancelled on 28 September 2017 and the medical expenses were incurred after the cancellation of your policy.
A formal rejection letter will be forwarded to you once signed off by Management”
My response to them on the above findings:
would just like to know as to why the policy was cancelled.
Last year we had no idea that the matter is so urgent as he was under Physio therapy for almost a year before the final opinion.
Our medical aid was exhausted and therefore we could not proceed with any scans or operations.
And their response to me as below:
Dear Mrs Gaffoor
With regards to the cancellation of your policy, your email has been forwarded to the relevant department to respond to you.
In relation to the claim submitted, please be advised that all claims are assessed subject to the terms and conditions of the policy.
Kindly refer to your policy wording for clarification on cover.
Nirvasha Naidoo Claims Officer, South Africa Ground Floor, the Bridle, Hunts End Office Park, 38 Wierda Road West, Wierda Valley, Sandton, South Africa O +27 (0) 11 ********** F +27 (0) 11 ********** Chubb. Insured”
Another response from the relevant department :
Dear Mrs Gaffoor,
In respect of your query below as to why your policies were cancelled, the broker on your policy was Proactive Connect.
In April 2017, Proactive Connect approached Chubb to advise us that they would like to cancel the book of business.
Unfortunately, Chubb was not able to continue this book of business and a decision was made to cancel the entire book of business. Attached please find copies of the letters that were sent to you at the last known address that we had on record for you. The affected policies are:
· PRO ********** 964T; · PRO ********** 965T;
In addition, we have received confirmation from the administrators of the policy that the letters were successfully delivered to address thereon and that no further premium was collected from you from 1 October 2017 which is the date the policy was effectively cancelled.
Should you have any further questions or queries, please do not hesitate to ask.
My response to them again whereby I had no response to date.
This is unacceptable for the following reasons:
· This letters were never delivered to my home address – what proof do they have the letters were posted to me as this is the first time seeing this letters. Do you now for one moment think I would not have taken this up with the insurer and I would have made alternative arrangements and nobody contacted me.
· Did someone sign for the letters perhaps that they could confirm that the letter were successfully delivered.
· When Chubb took over wasn’t it there responsibility to ensure that all the policy holders in the book of business are aware about it. Even if it means Pro-active had to do it and you had to get confirmation from them.
· You said that the cancelled in 1 October, but a payment still went off in November 2017.
Your response on the above is required please.
I trust you can kindly assist with this matter Hello Peter. I`m just thinking what would have happened if my son maybe lost his leg, arm or whatever ligaments. This is not fair at all. I would really be greatful if i can get any assistance in getting this matter resolved as i totally do not agree with their findings. I’ve attached all relevant information and i have proof of all correspondence between me and them and the final claim form with the relevant supporting docs as requested by them.
Thank you and kind regards
Raynia Gaffoor ********** 626 / ********** 650