FS
Francisca S

1 reviews | Active since Aug 2019

27 Aug 2019, 15:40

Dread Disease Cover (Not so adequate cover)

<div>My Dad took out Dread Disease Cover in 2008. He was approached by an IFA representative. He did not receive any policy documents but for some 2 page pamphlet.

In 2017, my Dad had "heart failure, and myxomatous degeneration of the mitral valve causing severe mitral regurgitation".

In 2018, we submitted a claim. The claim was repudiated on the ground of the "Exclusion Clause". In that the cause of the dread disease existed before conclusion of the Policy.

We escalated the issue to the "Independent Arbitrator". The "Independent Arbitrator" found in favour of the Company. However, the reason for upholding the repudiation were different. The ground for repudiation was now that my Dad had not suffered a heart attack.

We have now requested all the policy documents in order to take the matter to the Ombudsman. However, I felt compelled to write this review in order to warn other families of the clauses that we are not made aware of when taking out such Policies. Especially when the Policy is sold by the IFA people.

The different reasons for repudiation just confirm that insurance companies will look for any technicality to repudiate claims. Further, if a disease like heart failure and/or degeneration of the heart valve is not covered under "dread disease" then what is? And do you actually have adequate cover?

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Replies (1)
Clientele Life
Clientele Life's reply27 Aug 2019, 15:53
Official
 Dear Francisca S Our records indicate that you also escalated this matter  to the Independent Arbitrator for review.   We are therefore not in a position to respond to the concerns raised.  The Arbitration Department is a higher authority that has been commissioned by Clientele Life with the mandate to review any queries referred to it. Any determination made by the Independent Arbitrator is final and binding on the Company and we will be guided by his response. Please note that we have escalated your query to the Independent Arbitrator's office and  you can expect a response shortly.  We trust this is all you require in this regard however, should you require further assistance please do not hesitate to contact us again. 

 Kind Regards,  Lindiwe Mabizela Service Recovery Specialist