Misleading and Contradictory information

Good day

I have rep**** and sent supporting documents as well.

Hoping to hear from you soon

I am absolutely disgusted that nearly a month has passed since your generic reply on 23rd December promising "feedback will be provided via email". To date, I have received ABSOLUTELY NOTHING. Your complaints management is non-existent. You have ignored my direct emails, you have ignored my internal escalations, and most alarmingly you are now stalling the National Financial Ombud Scheme by failing to respond to their requests for information. Your company took R7700 from a grieving family under the false premise that it would settle arrears for a claim, only to decline it once the money was in your hands. This is predatory, ********* and a gross violation of the treating customers fairly framework. Stop hiding behind automated responses. We demand a human response, a refund of our money and an immediate explanation for why you are obstructing a regulatory investigation.

Your generic acknowledgment is an insult. I am not looking for a template response, I am looking for an explanation as to why you allocated the R500 that was paid in November, sent a statement in December that shows December missing premiums (insinuating that the policy remains active) and demanded R7 700 in December for all missing premiums but the policy lapsed??? We want detailed investigation findings, exact dates when the policy lapsed and why was money demanded from us under false pretenses. You are so *********** it’s sickening! Firstly, Shannon Wentzel referred this to the Arbitrator, yet we have heard absolutely nothing since 29/12/2025. Masibulele Ngalo has repeatedly moved the goalposts. After promising a resolution by 08/01/2026, he pushed it back again on 09/01/2026 with a vague excuse about "retrieving records” and since that last email, I have sent two emails which have been met with total silence. No acknowledgment, no update, no professional courtesy. I will no longer accept the excuse that you are waiting on the FSP. That is an internal administrative hurdle that is not my concern. You have had more than enough time to retrieve records. It has been over a month since my grandmother passed and we need to deal with the emotional turmoil you put us through while we are grieving??? You are heartless!
We demand the feedback TODAY and definitive copy of your internal findings.

Ohhhh and I will no longer accept the excuse that you are waiting on the FSP, that is an internal administrative hurdle that is not my concern! You have had more than enough time to retrieve records!

The core of my complaint falls under the liability and decision making authority of the Insurer regardless the ongoing servicing of the FSP. In your records as the Insurer when did the policy lapse? Why issue a repudiation letter without proper liaison with the FSP? On what basis did you as the Insurer deemed the policy as lapsed????

You can not be referring to the email I received from Shannon Wetzel!! IS THAT FEEDBACK???
Old Mutual (Shannon Wetzel) stated that the internal review of the case is finalized, however Old Mutual is refusing to disclose the outcome, claiming you can now only communicate through the NFO office.

As a consumer, I have every right under TCF Outcome 3 and PPR Rule 18 to be informed of their final decision made. We have every right as a family to know what the final internal decision was! Your attempt to deflect the query to NFO is a clear move to avoid accountability! If the process is completed then why are you upholding the outcome? This a demonstration of bad-faith tactic and direct violation of legal and regulatory framework.
The NFO manages the dispute but the insurer is still legally required to justify their decision to the client as part of their internal complaints process.

Stating that the process is finalized and refusing to tell me the outcome is a clear indication of failure to provide adequate reasons. The existence of an NFO case does not override this statutory duty.

I DEMAND FEEDBACK TODAY!

I refer to your correspondence dated 23 January 2026. I am appalled by the contents of your letter, which not only contains factual inaccuracies but also demonstrates a fundamental breach of the Long-term Insurance Act and the Policyholder Protection Rules.
Please consider this my formal rebuttal. I am placing the following legal facts on record:

1. Liability for the FSP (Section 47 of the LTIA)
   You state that my "appointed service provider" remains the FSP and that you are "only the underwriter." This is legally incorrect.

Under Section 47(3) of the Long-term Insurance Act, the payment of a premium to an authorized intermediary is deemed to be payment to the insurer.
Principal-Agent Liability: The FSP is your chosen agent. Any administrative hurdles or reconciliations between Old Mutual and Thapantha are internal corporate matters. Legally, the FSP stands in the gap for the insurer. If the FSP accepted partial payments and marked the policy as active, Old Mutual is bound by those representations.

2.Admission of Active Status (Waiver and Estoppel)Your email explicitly states, "HOA covered the premium shortfalls in good faith to keep the policy active." Legally by admitting that the FSP (your authorized agent) acted to keep the policy active you have waived any right to rely on a lapse clause. In South African Insurance Law, once an insurer (or its agent) performs an act that acknowledges the continued existence of a policy, they are estopped/legally barred from later claiming the policy had lapsed.
You cannot claim the policy was lapsed for the purpose of a claim while simultaneously admitting it was "Active" for the purpose of premium collection.

3. I have identified a transfer of R5,600 made on 20 December 2025. I wish to formally acknowledge receipt of this amount, which was processed amidst the day of my late grandmother’s funeral and I had no knowledge of. The "Panic Refund" of 20 December is a clear admission of guilt. On this day the FSP transferred R5,600 back to my account without any notification. This refund occurred two days after they took R7,700 but two days before they officially submitted the claim to you. Legally this proves the FSP realized that collecting R7,700 as a barrier to claiming was a gross violation of PPR Rule 17. They attempted to rectify their records before you saw the file. However, they unilaterally retained R2,100, which constitutes an unauthorized and ******* set-off.

4. Your repudiation letter states the claim was submitted on Monday, 22 December 2025. This is factually incorrect. I was physically present at Newton Park, PE branch on Thursday, 18 December 2025. I submitted the claim documents to your representative in person that day. On the 18th, I was explicitly told by your representative that the claim would not be accepted unless I paid R7,700 in arrears. I paid this amount in-branch, under duress, as a prerequisite to filing my claim. It is now evident that the FSP intentionally delayed forwarding the claim to Old Mutual until 22 December to create a false timeline and process a partial refund on the 20/12/2025 in the interim to mask their ******* collection.

5.Breach of the Course of Conduct Principle
Your email admits that partial payments (R400/R500) were received "throughout the lifespan of the policy."TCF Outcome 3: You have a duty to provide clear information. You cannot accept partial payments for months, lead me to believe I am covered, and then strictly enforce an R800 requirement only after a death has occurred. This is the definition of Bad Faith.

6. The Statutory Reset of the Lapse Cycle
You have ignored the fact that a payment of R500 was allocated on 30 November 2025.Under PPR Rule 15, this payment successfully broke the consecutive chain of non-payment. Even if the policy was in arrears, it was not lapsed. A policy "in arrears" is a payable claim, subject only to the deduction of the outstanding premium. Furthermore, your letter admits the FSP "kept the policy active" by covering shortfalls. If the policy was active in your agent's ledger, it was active for the purposes of the claim.

7. The most critical evidence remains the FSP’s written confirmation on 11 November 2025. Please see WhatsApp communications attached.

• On the 10th of November the FSP alerted me that the policy status has changed to lapse.
• After I provided the 4 November Proof of Payment, the FSP explicitly retracted the "Lapsed" status, stating I was "lucky however your policy seems to also be in arrears" and “next time your policy will lapse”. This confirms that as of 11 November, the FSP (your authorized agent) acknowledged the policy was in-force. You cannot be "in arrears" on a policy that has already lapsed. By their own admission, the 4 November payment kept the policy in-force.

• Under Section 47(3) of the LTIA, Old Mutual was "on risk" from that moment. You cannot rely on a reconciliation done on 15 December to retroactively lapse a policy that was confirmed as active on 11 November.
• You state the FSP is my "appointed provider." This is a legal fallacy. Under Section 47(3) of the LTIA, the FSP is the agent of the Insurer.

• When I stood in your Newton Park branch on 18 December and paid R7,700, I was dealing with Old Mutual's authorized representative.

Any dishonesty or administrative "lag" between the FSP branch and Old Mutual is an internal liability. The Insurer remains "on risk" for the representations made by its branch staff. The FSP's timeline is fabrication. The WhatsApp evidence from 11 November confirms the policy was active. The 20 December refund proves they handled the claim in bad faith.


I am dissatisfied with the decision to maintain the claim decline. Based on the legal principles of Principal-Agent Liability and Section 13 of the FAIS Act highlighted in my previous correspondence, the Insurer remains legally responsible for the actions and representations of the FSP. I do not see how the claim can remain declined when the FSP was acting within their mandate. Please provide a detailed explanation as to why these specific legal obligations have not changed your position.