Formal Complaint – Dispute Regarding Claim Settlement – Claim No. ***

Dear Old Mutual Insure Complaints Department,

RE: FORMAL COMPLAINT AGAINST OLD MUTUAL INSURE LIMITED – MISREPRESENTATION AND INCORRECT INFORMATION PROVIDED AT POINT OF SALE
Policy No: ***
Claim No: ***
Insurer Complaint ***

I hereby wish to formally escalate my complaint regarding the information and advice provided to me by the Old Mutual Insure consultant at the time I took out my Allsure Household and All Risks policy.

I am extremely disappointed and frustrated with the manner in which my claim has been handled, particularly because I have maintained this insurance policy and paid my premiums as required, yet I have now been without my cellphones for almost three weeks while I am still trying to resolve an issue that, from my perspective, arose because I was given incorrect or inadequate information when the policy was sold to me.

1. BACKGROUND

When I took out cover for my two cellphones, namely:

- Samsung A14 – insured amount: R6,000
- iPhone 13 Pro Max – insured amount: R30,000

I re**** on the information provided to me by the Old Mutual Insure consultant who sold me the policy.

My understanding, based on the explanation given to me, was that if I suffered a valid loss, I would be covered in accordance with the amounts for which my devices were insured. I therefore understood the amounts of R6,000 and R30,000 to represent the level of cover applicable to my respective devices.

I re**** on this representation when deciding to take out and maintain the policy. I have paid my premiums and fulfilled my obligations as a policyholder.

I subsequently submitted Claim No. *** following the loss of both devices.

I was then informed that the proposed settlement was:

- R2,800 for the Samsung A14, despite the device being insured for R6,000; and
- R26,599 for the iPhone 13 Pro Max, despite the device being insured for R30,000.

I was advised that the settlement was calculated on a replacement-cost basis, rather than simply paying the amounts for which the devices were insured.

2. MY CONCERN REGARDING THE INFORMATION PROVIDED AT POINT OF SALE

My primary concern is not simply that the settlement amounts are lower than the amounts reflected as the insured values.

My concern is that this was not my understanding when I purchased the insurance, and I do not believe that the basis upon which the settlement would be calculated was adequately explained to me.

Had the consultant clearly explained to me that:

- the amounts reflected as the insured values were not necessarily the amounts I would receive in the event of a valid claim;
- the settlement would instead be based on the prevailing replacement cost of an equivalent item; and
- the insured amounts effectively represented a maximum limit rather than an amount that I could reasonably expect to receive,

I would have had a completely different understanding of the cover I was purchasing.

I therefore respectfully request that Old Mutual Insure investigate the conduct and advice provided by the consultant at the time the policy was sold to me and determine whether the product and its settlement basis were properly and adequately explained.

3. I SHOULD NOT BE PREJUDICED BY INCORRECT INFORMATION

I would like to emphasise that it is not my fault if I was given incorrect, incomplete or misleading information by the consultant.

As a customer, I re**** on the information provided to me by the representative of Old Mutual Insure. I am not an insurance expert, and I took out this policy in good faith on the understanding that the insured amounts reflected the protection I was purchasing.

If the consultant failed to properly explain the distinction between the sum insured and the actual replacement-cost settlement, I should not be left to suffer the financial consequences of that failure.

I entered into the insurance contract based on the information provided to me by Old Mutual Insure's representative. I therefore believe it is reasonable for Old Mutual Insure to take responsibility for investigating whether the advice and explanation provided at the point of sale were accurate, complete and sufficient for me to understand the nature and extent of my cover.

4. ALMOST THREE WEEKS WITHOUT MY PHONES

I am also extremely concerned about the length of time this matter has taken.

It has now been almost three weeks since I have been without my cellphones. These are not luxury items for me; they are essential communication devices that I rely on for my personal and work-related responsibilities.

I took out insurance specifically to protect myself financially in the event that something like this happened.

It is therefore extremely frustrating and disappointing that, despite having an active insurance policy and having paid my premiums, I remain without my devices while the matter continues to be disputed.

I appreciate that there may be procedures that Old Mutual Insure must follow when assessing a claim. However, I believe that my circumstances should also be considered, particularly where I maintain that my understanding of the cover was based on information provided to me by an Old Mutual Insure consultant.

5. REQUEST FOR A FULL INVESTIGATION

I respectfully request that Old Mutual Insure conduct a proper investigation into:

1. The information and advice provided to me by the consultant when the policy was sold;
2. Whether the consultant clearly explained the basis upon which a claim would be settled;
3. Whether I was properly informed that the insured amounts of R6,000 and R30,000 represented limits of compensation rather than guaranteed settlement amounts;
4. Whether the advice provided to me was accurate, complete and not misleading;
5. Whether the policy was sold to me on the basis of an understanding that differs materially from the actual terms and settlement methodology app**** to my claim; and
6. Whether Old Mutual Insure should provide appropriate redress in circumstances where I re**** on information provided by its representative.

I further request that Old Mutual Insure review my claim and the proposed settlement amounts in light of the circumstances outlined above.

6. REQUEST FOR DOCUMENTATION AND EVIDENCE

I also request that Old Mutual Insure provide me with the relevant documentation re**** upon when determining my settlement, including the calculation and replacement-cost information used to arrive at:

- R2,800 for the Samsung A14; and
- R26,599 for the iPhone 13 Pro Max.

I would also appreciate a clear explanation, in plain language, of why the amounts for which the devices were insured were significantly different from the settlement amounts offered.

7. CONCLUSION

I am lodging this complaint because I genuinely feel that I have been disadvantaged despite acting in good faith as a policyholder.

I took out insurance because I wanted protection in the event of loss. I paid my premiums and comp**** with my responsibilities as a customer. I re**** on the information provided to me by the Old Mutual Insure consultant when deciding to take out and maintain this policy.

I therefore cannot accept that I should simply bear the consequences if the information provided to me at the point of sale was incorrect, incomplete or inadequately explained.

It is not my fault that I was given incorrect information. I re**** on the advice of an Old Mutual Insure representative, and I believe Old Mutual Insure has a responsibility to investigate the matter fairly and take accountability if its representative failed to properly explain the nature and extent of the cover.

Furthermore, having been without my phones for almost three weeks while this matter remains unresolved has caused me considerable inconvenience, frustration and distress.

I respectfully request that this complaint be escalated to the appropriate senior complaints authority within Old Mutual Insure and that I receive a detailed written response addressing each of the concerns raised above.

I remain willing to provide all supporting documentation, including my policy schedule, claim documentation, previous correspondence, the original complaint and Old Mutual Insure's response under complaint reference ***1.

I sincerely hope Old Mutual Insure will reconsider my circumstances and resolve this matter fairly and urgently.

I look forward to receiving your written response.

Kind regards,

Sipho Gift Maseko
Policy No: ***
Claim No: ***
Cell: +***8
Email: ***