DO NOT TAKE UP OLD MUTUAL COVER -

I am writing to formally lodge a complaint regarding the denial of my claim for Critical Illness Cover, specifically with reference to my diagnosis of Type 1 Diabetes. I was deeply disappointed to learn that Old Mutual does not consider Type 1 Diabetes as a severe illness, despite its potential to lead to severe complications such as heart failure, kidney failure, and other vital organ failures. These complications, as recognized by the World Health Organization (WHO), can result in death or coma, thereby categorizing the condition as a life-threatening illness.

When I purchased my Critical Illness Cover, I was led to believe that it would provide protection against conditions that pose significant risks to my health and life. However, I was informed that my claim was denied because Type 1 Diabetes was classified as a “mild illness,” not a “severe” one. This classification is neither accurate nor reasonable, as Type 1 Diabetes is widely acknowledged by medical professionals and organizations worldwide as a serious and potentially fatal condition.

As a policyholder, I do not possess the expertise required to distinguish between “mild,” “severe,” or “light” illnesses. I trusted Old Mutual to provide a clear understanding of what conditions were covered, yet the terms and definitions regarding illness severity were not adequately explained at the time of purchase. I do not believe it is reasonable to expect customers to understand these classifications, especially given that the product was marketed as Critical Illness Cover, intended to protect against severe health risks.

Furthermore, I am concerned that Old Mutual's approach to selling Critical Illness Cover may be misleading and not aligned with industry standards. It seems that, when customers require assistance, the company disclaims responsibility based on unclear and subjective classifications that are not transparently communicated at the point of sale.

Given these concerns, I will be lodging a formal complaint with the Financial Services Board (FSB) for investigation into both the product’s sale and the refusal to honor my claim. I believe it is critical that Old Mutual review its practices, clarify its definitions of illness severity, and adopt more transparent communication with policyholders to prevent similar issues from arising in the future. I request an immediate review of my claim and a formal written response addressing my concerns.