Claim rejection invalid!

I am writing to formally lodge a complaint regarding the handling of my claim (*** and CAE***5) and the unacceptable service I have received throughout this process.

Background:

As per your stated claim requirements, approval would be granted should any three of the following clinical criteria be met:

Systolic BP > 160

Diastolic BP > 110

Oedema

24-hour urine protein > 3g

My initial claim was rejected on the basis that I failed to provide proof of either:

Diastolic BP > 110 or

24-hour urine protein > 3g

As my treating gynaecologist was on leave during my hospital admission, I was advised by him to obtain my clinical records directly from the hospital. I did so, at my own expense, and submitted documentation showing that on 1 January 2025, my blood pressure was recorded at 162/113. This clearly meets the criterion of a diastolic reading >110 and should qualify the claim.

Despite submitting this supporting documentation (on 25 August 2025), and confirming with the call centre multiple times that the documents were received and linked to my claim, I received another rejection citing the same reason—that I had failed to provide adequate proof. This is factually incorrect, as I have now submitted the relevant evidence multiple times.

In addition, my broker, also submitted the same documentation on 26 August 2025. We both received automated references confirming receipt.

I followed up with your call centre no less than four times, and despite assurances that the documents would be allocated to my claim, I have been told repeatedly that the case is closed and no additional documents have been received.

Failure to process valid evidence submitted in line with your requirements.

Repeated miscommunication and false assurances from your call centre.

Negligent handling of documentation, causing significant delays and stress.

Unacceptable customer service, particularly in light of the traumatic medical event I endured (hospitalization, emergency C-section, premature birth, and NICU stay of 50 days for my daughter).

Lack of accountability and escalation pathways – I was told there is no manager I could speak to.

What I Am Requesting:

A formal reassessment of my claim based on the documentation provided (BP reading of 163/113 on 1 Jan 2025).

A detailed explanation as to why this submitted evidence has not been accepted despite clearly meeting your clinical criteria.

Immediate reopening of my claim and a formal written response within 7 working days.

An acknowledgment that my claim was handled inappropriately, along with details of any remedial steps being taken.

Should I not receive a satisfactory resolution, I will have no choice but to escalate this matter to the Long-term Insurance Ombudsman.