Formal Complaint: Poor Customer Service, Unprofessional Conduct and Delayed Partial Approval of Claim – Request for Full Settlement

Policy Holder: Mmamoleke Thelma Mosupyoe Policy No: *** Claim No: ***

I am writing to formally lodge a complaint regarding the handling of my insurance claim. This complaint relates to poor customer service, unprofessional conduct, excessive delays, and the partial approval of my claim, which has resulted in financial prejudice and unnecessary distress. 1.⁠ ⁠Excessive Delays, Poor Customer Service and Unprofessional Conduct The claim was logged on 02 January 2026, however final feedback was only received on 02 February 2026, a period of approximately 4 weeks. During this time, there was a persistent lack of communication, delayed responses, and repeated failures to provide meaningful updates. Progress on the claim was only achieved after numerous follow-ups and persistent calls from my side. The manner in which the claim was handled was unprofessional and fell well below reasonable service standards, including: Failure to return calls or provide promised feedback Vague and inconsistent communication Lack of accountability when enquiries were made Unreasonable delays without clear justification As a policyholder, I expected professional, transparent, and customer-focused service, which was not demonstrated throughout the claims process. 2.⁠ ⁠Partial Approval of the Claim The initial repair cost, as assessed by the Old Mutual-appointed assessor, amounted to R25 804.34. Despite this, only R18 158.00 was approved. The reason provided for the partial approval was that the property was allegedly underinsured. This is of serious concern, as underinsurance was never communicated to me prior to the loss, nor was I advised at any stage that my policy cover was insufficient or required adjustment. As a policyholder, I reasonably re**** on Old Mutual to ensure that my cover was appropriate and aligned with the insured risk. 3.⁠ ⁠Previous Claim History I further note that a similar claim submitted in August 2020 was declined by the same insurer. The repeated outcome of declined or partially approved claims raises concerns regarding fairness, consistency, and adherence to principles of good faith and fair customer treatment. Requested Resolution In light of the above, I formally request: A full review of the claim decision. Full approval of the claim, covering the total repair cost of R25 804.34. A written explanation as to why underinsurance was not communicated prior to the loss. Feedback on the unprofessional handling of my claim and measures implemented to prevent a recurrence. Should this matter not be resolved satisfactorily, I reserve the right to escalate the complaint through internal escalation channels and, if necessary, to the Short-Term Insurance Ombudsman. I trust that this matter will now receive the urgent attention it deserves and look forward to your written response. Yours faithfully, Mmamoleke Thelma Mosupyoe