Bad experience with Platinum Life

I had a very bad experience with Platinum Life. My mom was diagnosed with ovarian cancer in 2021, her cover with Platinum paid out quickly and she was very grateful for the financial breather. After some time, my mom was encouraged to upgrade her policy, and she was under the impression that she was still covered, given the fact that she was (for a time) cancer free and that any female cancer that might later be found would be an independent new cancer. She kept paying her premiums - I know my mom wanted us to be okay when she passed. It was never explained to her that if she was diagnosed with the same cancer, there would be no pay-out. When I called to question this I was told that “she had the documents and she should have read it.” My mom was in no state to understand any document at that point, and if we had known at the time that she had upgraded her policy we would have sat with her and made sure she understood. Unfortunately, in September 2023, mom lost her battle with cancer. We tried to lodge a claim with Platinum Life, but they refused to send us the claim forms. After some back and forth we were told that there was no claim because mom passed of ovarian cancer. My issue here is that: • We weren’t allowed to lodge a claim. We have notified Platinum Life that we can’t follow their complaints procedure because they won’t allow us to claim and lodged a complaint directly with the Insurance Ombudsman. • 2. The decision to not allow our claim to be lodged was not made by a doctor, it was made by a claims administrator. Wording in my mom’s last diagnostic report states: “Large solid cystic mass in the pelvis with distortion of the pelvic organs. Unable to identify if the mass originates from the ovaries or the uterus. Inseparable from the ****** and sigmoid (suspicious for infiltration).” Surely a diagnosis like this should be made after some investigation and then by a doctor? Honestly, it feels like this is a way for Platinum to keep their figures looking good. High percentage of claims paid, but that’s because they refuse to entertain a claim that might be rejected, it’s bad for the numbers.