Claim declination - case with Ombudsmen - Ombudsmen ref no: D667/16A

<p>policy ********** 048</p> <p> </p> <p>after having been involved in a terrible archiles tendon sport injusry and spending few months in hospital. I ended up with heavy doctors bills charged at 300% , and Discovery Health paid only 100%. It so happened that my car premium for that month did not go through....and I wrote to Discovery Insure asking for the premium to be raised on 25 Nov along with the following months' premium. I received NO RESPONSE which gave me an indication that my request was granted. NB: Both medical aid and car / household insurance with Discovery....</p> <p> </p> <p>On the 14 th of Nov around 20h30, my wife was involved in a terrble car accident, and on calling Discovery Insure, tehy authorised towing of the car and everything *ref for towing given was LC-TXHA-01. Few hrs later, Discovery Insure tells me due to unpaid premium, the claim cant be paid. I called them on 15 Nov to explain the confusion, cause by then my car was stuck with the towing company they had authorised to pull my car. Post this call (on teh 15th), they sent me a note confirming my policy was lapsed on the 15th of Nov 2016.....note the accident happened 14 Nov...copy of all correspondence as quoted below</p> <p> </p> <p>"quote"</p> <p> </p> <p> </p> <p>15 November 2016</p> <p>Discovery Insure Plan number: ********** 048</p> <p>Your Discovery Insure policy has lapsed due to unpaid premiums</p> <p>Dear Thabani</p> <p>We have lapsed your Discovery Insure Plan on 15 November 2016. This means that you will no longer have access to the benefits and services we offer or be able to submit any claims to us from 24 October 2016 onwards.</p> <p>Please note, that if you have a DQ-Track device installed, you must arrange a deinstallation for the device, or you will be held liable for payment of the device.</p> <p>If you have any queries or would like to find out more about Discovery Insure in the future please contact your financial adviser or call us on ***.</p> <p>Kind regards</p> <p> </p> <p>Francois Theron<br /> Chief Operating Officer<br /> Discovery Insure <br /> </p> <p>2)</p> <p>My original email to Discovery dated 31 October</p> <p> </p> <p>“quote”</p> <p>From: ********** /> Date: 01 November 2016 at 10:47:27 SAST<br /> To: ********** /> Cc: '''Thabani Dlamini''' ********** /> Subject: Re: Your Discovery Insure Policy - ********** 048 -MailRef# ********** 369#-</p> <p><br /> goodday<br /> thanks for your email. am just having a small challenge currently, but please may I ask that you charge this Nov premium on Fri 25 Nov please....<br /> <br /> rgds<br /> Thabani Dlamini<br /> <br /> Effingham Heights,<br /> Home: ********** 749</p> <p> </p> <p>3)</p> <p>Discovery SMS (with the ref no), sent to me by Discovery confirming authorization for the tow truck to take the car away….sent 14 Nov 2016 @ 20h55</p> <p> </p> <p>“quote” Dear MR THABANI G DLAMINI, Kurt's Towing & Recovery has been authorised to assist. . The service provider will assist you shortly. Ref. No.: LC-TXHA-01.”unquote”</p> <p> </p> <p>“unquote”</p> <p> </p> <p> </p> <p>Brgds</p> <p>TG Dlamini</p> <p> ********** 356</p> <p>Email: ********** (work)</p> <p> "unquote"</p>