DJ
David J

1 reviews | Active since Mar 2009

03 Apr 2024, 00:18

Beyond the grave :Claim repudiated. Deceased's email address used

My son James died of cancer on 22 June 2020. He had a contract to provide Gap Cover with this company. As he had died the original claim was sent to them by Heather Smit on 25/08/2022 for services rendered in April 2022. Communication was sent regarding outstanding documents to my deceased sons email address even though the company was fully aware that he was on his deathbed. The company failed to send the follow-up communication to Heather Smit who had lodged the claim in the first place – request was sent out on 06/09/2022 they say they had received no communication nor the outstanding documents were sent to Stratum by 31/12/2022 when the claimable period expired. They furthermore advise that they received a follow up request on the outstanding claim in October 2023 to which we advised that the claims are now stale as its older than 12 months and the outstanding documents have not yet been received.

I have pointed out the above facts to the company and they are still refusing to pay the claim. They were completely aware of the condition and diagnosis and are now relying on the fact that they communicated with an email address that was no longer in use. They were provided with an alternative email but failed to advise Heather Smit that they had further requirements and have simply repudiated the claim.

0
Replies (4)
DJ
David J's update03 Apr 2024, 00:20
Reviewer Update
I need correct the date of death 17 June 2022
Stratum Benefits (Pty) Ltd
Stratum Benefits (Pty) Ltd's reply03 Apr 2024, 10:23
Official
Dear David,

Please accept our sincere condolences on the passing of your son.
 
We are sorry to hear about your dissatisfactions regarding your late son's claim/s. 
 
We have escalated your complaint to our claims management team for urgent assistance. Please expect feedback in the next 2-3 working days. 

We apologize for any unintended frustrations. 

Best regards, 
The Stratum Benefits Team 

DJ
David J's update13 Apr 2024, 11:21
Reviewer Update
I have heard nothing further. This is so disappointing. It has been absolute ages for them to respond. Looks like they are very badly managed.
Stratum Benefits (Pty) Ltd
Stratum Benefits (Pty) Ltd's reply08 May 2024, 15:21
Official
Dear David, 
 
Apologies for the misunderstanding. 
 
We confirm that your query has been escalated and reviewed. 
Confirmation of our position was e-mailed to your broker on 21/02/2024 (reference: ESTATE LATE ***** NETCARE N1 CITY HOSPITAL CASE NO ***), which we regarded as our final position on the matter. 
 
Your Hello Peter enquiry was submitted afterwards. 
 
We wish to confirm that Stratum Benefits position has remained unchanged in terms of our above-mentioned e-mail. 
 
The process has accordingly followed our Internal Claims Review / Dispute Structures and we have reached a conclusion. 
 
Should you wish to take this matter further, this may be done through the National Financial Ombud Scheme of South Africa (NFO).
 
 
Contact Details 
0860-800-900 
+27 (0) 66 *** 
*** 
 
Johannesburg 
110 Oxford Rd, 
Houghton Estate, 
Johannesburg, 
Gauteng, 2198 
 
Cape Town 
Claremont Central Building, 
6th Floor, 6 Vineyard Road, 
Claremont, 
Western Province, 7700  
 
Best regards, 
The Stratum Benefits Team