Formal Complaint Follow-Up – Lack of Acknowledgement and Action | Policy NYP***

Dear Dotsure Team,

I am writing to formally complain about the handling of my policy (NYP***) and the denial of my claim (NYP***) for an accident on May 21, 2025.

I believe your decision to decline the claim and void my policy is unjustified, and your management of this matter has been inconsistent and unprofessional, causing me significant distress. While I do not contest the cancellation enacted on June 4, 2025, effective May 31, 2025, citing alleged misrepresentation, I strongly disagree with this allegation and have lost all confidence in Dotsure as my insurer. I object to your decision to deduct the R6,649.00 paid for a valid home contents claim from the total premiums collected, as this unfairly penalizes me by offsetting a legitimate claim against unrelated vehicle premiums. Below, I outline my position and demand a fair refund calculation.

Grounds for Complaint 1. Unjustified Claim Denial and Policy Voidance

Your letter dated June 4, 2025, states that my claim was declined because you “reasonably concluded that [I] misrepresented/failed to disclose in full the insurance history linked to [me], [my] wife, and [my] property,” leading you to void the policy from inception under the “Dishonesty” clause. I strongly contest this conclusion.

When I app**** for the policy on December 12, 2024, I was asked if I had ever had a policy cancelled, to which I truthfully answered “no.” The previous policy, cancelled last year due to excessive claims, was in my wife’s name—not mine. Furthermore, after inception, I provided tracker certificates for our vehicles (2013 Audi A6 and 2015 Ford Ranger), including full VIN and engine numbers. With these details, you could have cross-referenced your records to identify any prior policies linked to these vehicles. I acted in good faith and provided all requested information, fulfilling my duty of utmost good faith under South African insurance law. If this history was material to your risk assessment, your underwriting process should have explicitly inquired about it or utilized the provided data. Your failure to do so does not constitute misrepresentation on my part.

2. Mismanagement of May 2025 Premium Payment

The handling of my May 2025 premium payment, detailed in my email of May 27, 2025 (attached), was marred by inconsistent communication and processes, exacerbating the situation:

May 6: You collected the premium. May 10: The funds were returned to my account. Your agent claimed no reversal showed in your system and promised a follow-up call on May 12, which never occurred. May 12: An SMS indicated the premium was unpaid. I was told a retry would occur on May 20 and to ensure funds were available, which I did. May 21: The debit was attempted a day late, after I had moved funds, assuming it had processed as scheduled. My wife’s accident occurred this day. May 22: I called, raising concerns about my active claim. Your agent, after consulting the claim handler, assured me the claim was “still pending” and unaffected by the payment issue, promising a call on May 26 to arrange payment (recording available). No call was received. May 26: I was told coverage would be pro-rata (May 26–31), a detail never previously mentioned, despite my repeated inquiries. Your policy wording states, “If we do not receive your premium by the due date or within 15 days after the due date (‘grace period’), you will have no cover for that month.” The accident occurred on May 21, within the grace period (May 6 + 15 days = May 21). Your agent’s assurance on May 22 that the claim remained active led me to reasonably believe coverage persisted. This miscommunication, coupled with my offers to pay immediately (which you rejected), suggests you should be estopped from denying the claim due to your own representations and delays.

3. Unprofessional Handling and Lack of Communication

Your team’s lack of follow-through has been glaring:

Promised call-backs (May 12, May 26) never materialized. Agents were unaware of prior requests (e.g., questioning my bank statement submission). Updates were only provided when I initiated contact, despite my urgent pleas. An email from Samantha Daniels (Badger Holdings) lacked context, forcing me to research her role, and her 14-day response timeline ignored the time-sensitive nature of my claim. This conduct falls short of the “soft landing” and customer-centric service you advertise, amplifying my distress.

4. Unfair Refund Proposal

You propose refunding premiums “less any benefits paid.” My policy covers home contents (R255.88/month), two vehicles (R1,128.39 + R1,742.20 = R2,870.59/month), SASRIA (R19.75), totaling R3,146.22 monthly plus additional premiums for excess buster, platinum cover, and tracker payments. I have only claimed under the home contents portion, not the vehicles. The misrepresentation allegation pertains to the vehicles’ prior policy, yet I never claimed for them, and you had their details to verify. It is inequitable to offset a valid home contents claim (R6,649.00 for a TV) against vehicle premiums when the denial hinges on vehicle-related disclosure.

5. Unauthorized June Debit

Despite cancelling the policy, you debited my account for the June premium. This unauthorized charge further demonstrates your lack of care and consistency.

6. Ongoing Lack of Response and Failure to Investigate the Complaint

Following my formal complaint submitted on June 10, 2025, I received an acknowledgement from Cathy Murray stating the matter would be looked into. Yet, over 48 hours later, no response or update has been provided. I made multiple calls to your office on June 12, left messages, and was eventually informed by reception that Cathy Murray had stated she had no knowledge of the matter—despite confirming the previous day that she was reviewing it. This contradictory communication only reinforces the systemic mismanagement within your company and further erodes any remaining confidence in your process.

Policy Wording Supports My Position “Dishonesty” Clause: This applies to “deliberate or dishonest withholding of information.” I provided tracker certificates with full vehicle details, which you could have used to verify their history. My actions were transparent, not dishonest—your failure to act on this information is not my burden.

Unfair Deduction: Deducting the home claim from vehicle premiums violates the principle of severability, as the policy clearly delineates separate sections for home contents and vehicles. The alleged misrepresentation pertains solely to the vehicle section, not the home. Your “Treating Customers Fairly” commitment promises equitable treatment, yet this deduction is unfair.

Requested Action I demand the following:

Full Refund: Refund all vehicle premiums, excess buster, and platinum cover surcharges paid, with a detailed breakdown of the amounts. June Debit Refund: Return the June premium debited after cancellation. Response Deadline: Confirm the full refund in writing by close of business June 13, 2025, including the exact amount to be returned. Should this remain unresolved past the deadline, I will escalate the matter to the National Financial Ombud Scheme and seek legal recourse without further notice.

I expect immediate confirmation that my concerns are now being handled by someone with authority to respond meaningfully. This matter has already been subjected to unreasonable delays and a concerning lack of accountability.

Sincerely, Shaun Marais Policy Number: NYP***