PPS quick to take your premiums, but will never payout!

Good day

The complaint in question is regarding the refusal of payment of sickness and disability policy (income protector) from PPS to my wife. My wife has had sickness coverage in the event that she picked up an illness or became sick and was unable to perform her job duties for more than 3 years. The policy stated that the income protector would pay out in the event that my wife is booked off for more than 7 consecutive day by a medical doctor.

My wife went for a major surgery on 1 July 2021 and was booked off for 2 weeks by her medical practitioner, during which she was unable to work due to her being hospitalized. When we wanted to claim from the income protector, PPS requested us to fill in a request form. Up to this date my wife has never missed a single payment to PPS for any of her policies. Upon submission of the forms, PPS notified us that they will not be paying out any funds due to the fact that my wife noted on the form that she was a "teacher" and that PPS didn’t offer coverage to teachers.

My wife is not a teacher. My wife got retrenched from her pervious job last year (March 2020) to due Covid 19 related economical issues her company experienced. She was forced to make another plan for an income and so she got another job and started working as a contractor that tutors children online. The tutors in the company are called "teachers" to make it easier for the children to address them. Hence, the role name or position that my wife held in the tutoring company is called "teacher". Any person who joins the company, regardless if you have a teacher's qualification, is referred to as a "teacher".

PSS stated that their refusal to pay out the income protector is that they don't offer coverage to teachers in South Africa, so my wife was never covered since she was retrenched due to Covid 19. We have made numerous phone calls and sent numerous emails to PPS stating that my wife is in fact NOT a traditional teacher, since she doesn't even have a teachers qualification and thus it is ******* for her to practice as a teacher in South Africa. We continued to explain that she is in fact a contractor who so happens to work for a tutoring company (and the company refers to them as "teachers").

After more than 3 months of back and forward PPS reiterated that my wife is in fact a "teacher" and on that grounds they still refuse to pay. My wife was first retrenched due to Covid, and then forced to take on another job as a contractor to provide for our family (all of this time never missing a single monthly payment to PPS), then she had major surgery during which she was unable to work and racked up a lot of other medical expenses, and now when we want to claim for insurance that we had they refuse to pay out.

They did pay her back her premiums for the last year (which equated to about R2000), but she was supposed to get about R7000 for the 2 weeks that she was unable to work.

Covid 19 forced us into this situation and now PPS are reluctant to pay out her income protector due to a "technicality" which isn't even applicable to our situation!! PPS are just ********** who enjoy exploiting people who have already suffered under Covid. We will definitely take this to the ombudsman.