RP
Reuben P

1 reviews | Active since Jan 2013

11 May 2020, 21:45

Did I waste my 12 yrs premiums on a Severe Illness policy that refuses to pay as my Heart attack is not severe

If you were to spend the rest of your life talking to insurance advisors about policies they are selling, you would probably not find a single advisor who would be able to simply pull out a policy and explain it. The truth is that advisors don't fully understand policies. They just sell them. Most advisors won't even show you a copy of the policy they are urging you to buy. If you ever see a policy at all, it will probably be sent to you in the mail directly by the insurance company days, or weeks, after you have purchased the insurance. So at the time of sale, you don't know what you are buying other than what the advisor conveys to you. Insurance advisors are really nice. Otherwise, they wouldn't be able to sell you any policies. The same is true for claims adjusters. Otherwise, they wouldn't be able to settle any claims. It is important to distinguish these nice individuals from the company itself. The purpose of an insurance company is not to be nice, but to make money for its shareholders. If it makes more money than expected, the shares goes up. If it makes less money than expected, the shares goes down. When the share goes up, executives are given bonuses. When the share goes down, they are given headaches. The name of the game in the home office begins with the word "profits." Don't ever forget this. When the home office trains advisors or claims adjusters they don't tell them to be sinister. I don't think advisorss are taught to misrepresent coverage and adjusters are taught low-balling techniques. I wonder is the advisor told every little detail about the policies they are selling. They may know something about what is covered, but do they know very little detail about what is not. My severe illness claim was declined as my oxygen levels was not below 40% according to the contractual definition. But every website states that symptoms of a heart attack include loss of consciousness ( I blacked out requiring six stitches to my forehead and four to my right hand injuring myself when I blackout), fatique, breathing difficulties, sweatiness, blockage/ elevation of arteries preventing oxygen flow to the lungs and heart, heartburn. I experienced every one of these symptoms had to be rushed off the hospital emergency unit immediately given oxygen and have all tests done. Doctor unknown to me confirms that I had a heart attack but Old Mutual declines my claim under Myopathy as not being severe but they do not inform me that I may qualify for benefit under Heart attack. The advisors who no longer work for Old Mutual when asked why should I waste my money on severe illness when I have disability cover informed me that disability benefits are paid out when u are unfit to work and severe illess is upon diagnosis of a heart attack, stroke etc. Now we discover when claiming it must be really severe. If it's so severe it would require surgery which ultimately will lead to disability. Did I waste my money for the past 12 years paying for a product that will only pay out when it's so severe I can also qualify for disability. Advisors tell us that severe illness benefits are to help you cover bills, extra treatment etc but now I'm under more stress as I have medical shortfalls to pay, I have to cover the costs of doctors reports on the claim and i'll never be the same. What was meant to be a blessing during a heart attack is now becoming a curse. Old Mutual claim's process is becoming a curse totally opposite to what the missing Advisors promised. Believe me once you've suffered a heart attack you are never the same. There's no such thing as normal as everything including your lifestyle, diet etc changes. I guess Old Mutual cares more about profits and make their policies so air tight with the small print that ultimately the policy holder loses regardless of the cost. Collateral damage they call it.

0
Replies (3)
Old Mutual
Old Mutual's reply12 May 2020, 08:43
Official
Dear Reuben

I acknowledge receipt of your complaint. This matter will be investigated and I will be in contact with you.

Regards

Coleen Aanhuizen
Old Mutual Complaints  Management

RP
Reuben P's update21 May 2020, 22:28
Reviewer Update
It's more than a week and I am still waiting for Old Mutual to finalize the claim. One expects far better service from a company of Old Mutuals stature.
RP
Reuben P's update26 May 2020, 21:00
Reviewer Update
I went the extra mile when I should be resting to get the required documents from Nedbank, emailed it last Friday 22 May 20 all that is needed is for Old Mutual to do the necessary before it expires but once again the poor service continues. All I'm asking for is please get this matter resolved urgently as time is of the essence. A further delay will mean I shall have to pay extra interest which I want to avoid.