THE FACTS
PUKU Ringane from Pretoria had an Old Mutual policy that covered her for future illnesses.
When she was diagnosed with type 1 diabetes, she submitted all the relevant documents.
But her claim was rejected on the basis that they only cover type 2 diabetes.
Puku said this was unfair as she had not been informed of this before while continuing to pay for her premiums.
When her diabetes progressed to stage 2 and she could no longer work, she submitted another claim.
Once again, it was rejected as the policy only covers type 1.
WHAT I DID
I spoke to Old Mutual to find out why payment was not made.
SOLUTION
The company’s Carmen Williams told the SunDefender that diabetes is not listed in Puku’s policy and she isn’t covered for it.
As for Puku asking why Old Mutual didn’t inform her right away that the claim couldn’t be approved, it is standard procedure to investigate the validity of a contract before a claim can be assessed.
Regarding the medical report she paid for, they cannot reimburse her either as the company only pays for reports requested by them to show if she had any consultations before the date that cover began.
But Old Mutual is willing to refund Puku for the medical attendant’s certificate.
