Wrist joint fracture claim rejected ( Severe Illness Cover is a ****)

Sanlam has rejected a wrist joint fracture claim by stating that "We refer to your claim on the comprehensive severe illness disease portion of your plan for distal radial fracture. We are sorry to have learnt about your conditions. Sanlam accepts in all sincerity that the condition that you experienced is traumatic. Unfortunately, this specific condition is not defined contractually as a dread disease. I have attached a copy of the stipulations of the comprehensive severe illness benefits of the plan. We request that you kindly refer to the attached terms and conditions of the disease plan which provides you with an overview of the listed claimable events as well as specified criterion that has to be fulfilled in order to qualify for a valid claim. You will note that a distal radial fracture treated with an open reduction internal fixation, plates, *****s and a plaster of paris, is unfortunately not listed claimable events as per the contractual requirements of your plan and therefore a claim cannot be considered.

My responce to Sanlam: It's quite amusing that you're now altering your own terminology to validate your responce for a valid claim, when the claim form makes it clear what the claimable event is, and the contract refers to it as "wrist joint replacement" and not as this portion of your plan for distal radial fracture. I cannot find anywhere in the claim form nor in my medical report where I have or my Surgeon mention of '' distal radial failure ". This is just another typical endevour to get out of not settling a claim.

In light of the fact that this is a valid claim, I reiterate that I do not accept your ignorance. I have given Sanlam arbitration until the 28th of Sept COB to give me a final decision on this claim, failure which I will take the matter further. This is the same treatement I received 3 week ago with my camotose state leading to mechanical ventilation for at least 94hrs which you initialy rejected and not providing feedback, I had to use this plaform to get you to do the right thing. You should not have this product at all as its clearly, you dont live up to your own T's and C's.