Pure nonsense of Policies

Good day, can someone explain this english here... Metropolitan i really do not have time and energy for you, kindly send me my money without up and down, all my policies are more than a year but im being sent from piller to post. i submited the forms yesteday 10/10/23 and i expect my money within 48hrs please. im done with this up and down, where the hell do i get the money for up and down from. kindly tranfer my money as i was told the below by Alletta when yall refused to pay me now ts October still the same nonsence plz plz plz i need my money. We refer to your HelloPeter complaint of today.

We refer to your application for Metropolitan HealthCare CashBack cover policy ***

Policy start date 01/10/2022 Premium R761.00 Daily Benefit Amount of R1000

We agree that there is an automatic 3-month waiting period on the policy – see the following extracts from the User Guide & contract and from the policy schedule:

User Guide & Contract:

Policy Schedue, under notes and assumptions

We do agree that you were hospitalised just after expiry of the 3-month waiting period on natuarl causes of admission.

However, see the last paragraph under waiting periods that stipulates: “Condition-specific waiting periods of up to twelve months may be app**** to the policy” On the electronically uploaded application form, you were asked several medical questions, in order for us to assess the risk of insuring you for the benefits you app**** for under the policy.

You answered no, to all the medical questions, so no exclusions or waiting periods were added/indicated on your policy at inception date

Please also see the section in the User Guide on the importance of providing correct information:

We refer to your Hospital Cash claim:

Admission dates 01/01/2023 – 14/01/2023 Reason for hospitalization: Major depression According to the information provided by your Doctor (on the CMA) you were diagnosed with depression on 17/06/2022, just over a month prior to your policy application.

This contradicts your response to the medical questions posed to you at application stage Had you disclosed your diagnosis/condition, we would have placed a waiting period of 1 year on Hospitalization due to this specific condition (i.e. depression). Since you did not disclose this condition to us, we had no option that to repudiate your claim due to non-disclosure of your pre-existing condition.

We issued the attached endor*****t on 26/01/2023 and sent it to you with our claim repudiation letter of the same day. On the endor*****t it is stipulated that no Hospitalization claim resulting directly or indirectly from your Major Depression and relevant conditions will be payable within the first 12 months from entry date of the policy. This waiting period on Hospitalization due to Major depression and relevant conditions, will therefore expire on 01/10/2023. Therefore no claim for hospitalization due to depression will be successful if admission is prior to 01/10/2023.

We trust that the above addresses the concerns you have raised. We look forward to being of assistance to you again.