Formal Complaint Regarding Rejected Device Insurance Claim

To: Mr. Tshepo Debele Complaints & Declines Worldwide Advisory Services Email: ***

Cc: Ms. Tshepang Sefawanyane Ms. Ntombikayise Mello Ms. Boniwe Mkhondo

Dear Mr. Debele,

I am writing to lodge a formal complaint against Worldwide Advisory Services (WWAS) concerning your refusal to honour my insurance claim for a lost device under an active insurance policy. I find this decision to be both procedurally and legally unjustifiable and believe that it constitutes a breach of multiple South African statutory and regulatory obligations.

1. Context and Background Device Insured: iPhone 15 Pro Max 256GB Replacement Device: iPhone 16 Pro Max Date of Incident: January 2025 Policy Expiry Date: 28 February 2025 Monthly Premiums: Continued uninterrupted until the end of policy term

Following the trade-in of my iPhone 15 Pro Max, I contacted your office telephonically to notify WWAS of the device change to the iPhone 16 Pro Max. During that call, I was informed that your team would confirm with a line manager on whether the changeover could be completed. Despite this engagement, I received no follow-up instructions, documentation, or confirmation.

2. Legal and Regulatory Framework a) Duty of Good Faith – Common Law and Short-Term Insurance Act, 1998 Insurance contracts in South African law are governed by the principle of uberrimae fidei (utmost good faith). Both insurer and insured are legally required to act honestly and transparently. I fulfilled my obligation by informing WWAS of the device change. The failure to act upon or respond to my notification constitutes a failure to act in good faith on your part.

b) Policyholder Protection Rules (PPRs) under the Insurance Act, 2017 Rule 17 of the PPRs mandates that insurers treat policyholders fairly and without prejudice. WWAS’s inaction and refusal to update the insured device upon notification resulted in unfair treatment and caused prejudice, particularly as premiums continued to be deducted despite the device change.

c) Section 53 and 55 of the Short-Term Insurance Act Section 53 requires insurers to settle claims fairly in accordance with contractual obligations. Section 55 prohibits unfair claims settlement practices. In my case, the last confirmed insured device was the iPhone 15 Pro Max, which remained valid for claim purposes. The refusal to honour the claim under these circumstances appears to be arbitrary and in violation of these provisions.

d) Consumer Protection Act (CPA), 2008 – Sections 48 and 51 Your continued deductions for an iPhone 15 Pro Max after it had been traded in and replaced – and after I had communicated this to your office – amounts to an unfair, unreasonable, and unjust contract term as per Section 48(1). It is also potentially void under Section 51(1) for misleading conduct and failure to update material terms.

e) Precedent: Jerrier v Outsurance Insurance Company Limited (2012) In this landmark decision, the court ruled that insurers are obliged to process claims within a reasonable time and to avoid prejudicing the policyholder due to internal delays or miscommunication. WWAS’s prolonged silence and failure to act is inconsistent with this judicial precedent.

3. Summary of Key Issues WWAS was notified of the device change and failed to act upon that notice. ---Monthly premiums continued to be debited without updating the insurance record. -No written refusal or policy cancellation was communicated prior to the claim rejection. -The claim was submitted within the policy term, yet was unfairly declined.

4. Relief Sought Accordingly, I hereby request the following: -Immediate confirmation that my claim will be processed based on the last validly insured device – the iPhone 15 Pro Max 256GB. -Written explanation justifying how the failure to update the device despite my timely notice complies with Rule 17 of the PPRs. -Formal acknowledgement that the delay and miscommunication do not constitute grounds for rejecting the claim. -Commitment to resolve this matter within 5 working days from the date of receipt of this letter.

Should I not receive a satisfactory response, I will escalate this matter to the Ombudsman for Short-Term Insurance (OSTI), the Financial Sector Conduct Authority (FSCA), and other relevant statutory bodies, including public platforms, to ensure regulatory scrutiny and resolution.

I trust that you will approach this matter with the urgency and seriousness it warrants.

Thank you