SANTAM STRUCTURED INSURANCE LIMITED

Formal Complaint - Unfair Claim Rejection

I am formally lodging a complaint against Santam Structured Insurance Limited, the underwriter of my policy, regarding the unfair rejection of my claim by Prime South Africa. The premium reversal was a mistake caused by a banking error. On my app it appeared as a double debit, and when I went to the bank they confirmed it was an error correction. On 06.01.2026 we contacted Prime South Africa, explained the situation, and made arrangements for the debit order to go off on 15.01.2026. On that date, I spoke directly to Lungile and Zandile. Prime South Africa failed to debit on the 15th as agreed and made no attempt thereafter. On 19.01.2026, the morning of the accident, I called and spoke to Lesego. I explained that my wife had been in an accident and asked whether the insurance would still assist since the debit order had not gone off on the 15th. Lesego said she would consult her manager Madlynne. After consulting, Lesego called back and confirmed that if I made payment immediately, the insurance would still assist. Shortly after, Simphiwe called to speak to my wife (her phone was off at the time). I asked Simphiwe to provide banking details so I could make payment. He sent them, and I paid immediately. I then spoke to roadside assistance agents Sanke and Zikhona. Later that same morning, around 11am, Simphiwe called again to assist with the claim. Despite all of this, the claim was still declined with the excuse that the premium was “intentionally reversed.” This is false, misleading, and unacceptable. To add insult to injury, I was then told to collect my vehicle by 12.02.2026 and pay R4,000.00 in storage fees. Why should I pay storage when: We called to make arrangements. Prime South Africa failed to debit as agreed. We were instructed to pay in the outstanding premium before the claim could be processed, and we did. The premium was received, yet the claim was still declined. Storage costs are being unfairly pushed onto me due to your own failures. This is blatant negligence and bad faith. As the underwriter, Santam Structured Insurance Limited is ultimately responsible for the integrity of this policy and the fairness of claim decisions. The rejection of my claim is unjustifiable, and the demand for storage fees is outrageous. I will not pay any storage fees. You are required to overturn this decision and honour the claim immediately. Failure to resolve this matter will force me to escalate further through regulatory bodies, the Ombudsman for Short‑Term Insurance, and public platforms.