JR
Jacques R

1 reviews | Active since Dec 2019

06 Feb 2025, 13:27

Trying to avoid payments of claim based on a technicality

I am not at all happy with the service I have recieved from Admed Gap Cover, underwritten by Gaurd Risk. They rejected my maternity benefits claim on the grounds of a 12-month waiting period. I am dissatisfied with this decision and believe it to be unjust given my continuous coverage and the circumstances surrounding my policy. I have been a customer of Admed since 2023, and although I briefly switched to Stratum Gap Cover from Feb 2024 to Oct 2024 due to a change in employment, I returned to Admed in October 2024. Both Admed and Stratum Gap Cover are underwritten by Guardrisk, and I have had uninterrupted coverage in this period, with no lapse in my medical gap cover. While I understand that a 12-month waiting period might apply in certain circumstances, I do not believe it should apply in my case, given that my gap cover remained under the same underwriter (Guardrisk) and the transition between Admed and Stratum Gap Cover was seamless. The change in provider was purely due to my employment status, and the nature of the underwriting remained unchanged, which should have ensured my continuity of coverage and benefits. I find it concerning that the claim is being rejected on what seems to be a technicality, rather than on the merit of my continuous coverage and timely premium payments. I would like to request a thorough review of my case and a reconsideration of the rejection. I am confident that my policy was uninterrupted and that I should be entitled to the maternity benefits, as I have adhered to the policy requirements. Should this matter not be resolved promptly, I will be left with no option but to escalate my complaint to the relevant industry authorities, such as the Financial Services Ombud, as I believe that I am being unfairly treated

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Replies (1)
Guardrisk Insurance
Guardrisk Insurance's reply06 Feb 2025, 14:34
Official
Dear Jacques R 

Thank you for raising your concerns with us.  

The query has been escalated to the relevant team for investigation and you will be contacted for further assistance.  

Feel free to contact us should you need anything else.

Regards 
The Guardrisk Team 
Email: ***