HELLOPETER.COM
Formal Complaint Re: : Confidential: [Ticket#2026042169001945] Fwd: Outstanding claim ONE:251736096

To whom it may concern,

Subject: Formal Complaint – Incorrect Capture of Policy Information and Refusal of Valid Hospitalisation Claim

I write to formally lodge a complaint regarding the handling of my pet insurance policy and a recent hospitalisation claim for my pet, Chleo.
I have historically been a loyal and satisfied OnePlan customer and have regularly praised the service, efficiency, and support provided. Unfortunately, that is no longer the case.

I was informed that information relating to my policy was captured incorrectly. This administrative error has directly resulted in confusion and misrepresentation of my benefits and has materially affected my understanding of the cover for which I am paying. This is unacceptable.

Since discovering these discrepancies, I have made numerous attempts to resolve the matter through multiple emails, phone calls, and follow ups. Despite my efforts, the issue remains unresolved, and I have received no clear, consistent, or satisfactory explanation. This lack of resolution has caused significant frustration and distress.

I was subsequently advised that my pet may not be covered for hospitalisation, and my claim was refused without proper investigation, despite the fact that Chleo was admitted and kept overnight at the veterinary hospital.

Hospitalisation Costs Incurred
• Initial hospitalisation deposit: R3,500.00
• Additional payment upon discharge: R842.91
• Total paid: R4,842.91
• OnePlan contribution: R1,500.00
• Out of pocket: R3,342.91

I proceeded with the treatment without hesitation, relying on my long standing understanding that my policy covers emergencies and hospitalisation. As a premium-paying customer who pays an additional amount per month so that excesses would be covered for hospitalization or operations, I reasonably believed that my pet would be fully supported.

I submitted all invoices and receipts, which clearly indicate hospitalisation. No claim form was provided by the vet, so documentation was submitted directly as advised.

To my shock, I received an abrupt response stating that no further refund was due as the emergency casualty fee had already been loaded onto the card and that the case was closed. Subsequent enquiries were met with the same dismissive response.

The only meaningful engagement occurred when Karen Vorster contacted me, reviewed the claim, and identified that the claim had been incorrectly captured.

She separated the emergency and hospitalisation portions of the invoice and acknowledged the issue. I appreciated her assistance and finally felt heard.
Regrettably, no follow up communication was provided thereafter. I later received confirmation from another representative that the claim was again rejected. When I queried this, I was advised simply to “complain,” with no attempt to resolve the matter or advocate on my behalf. This marked a complete deterioration in service and support.

If the current interpretation of my policy is correct, this raises serious concerns regarding:
• Misrepresentation of benefits
• Failure to disclose material limitations
• Administrative negligence during onboarding
• A significant mismatch between premiums charged and benefits provided
I formally require the following:
1. Written confirmation of the full extent of cover applicable to my pet, specifically regarding hospitalisation and related veterinary treatment.
2. A detailed written justification for the monthly premium of R560.00 should hospitalisation cover be limited to R1,500.00.
3. Immediate correction of all inaccurately captured policy information.
4. Rectification where applicable, including reimbursement, correction of cover, or premium adjustment, retroactively effective from the date my pet was added to the policy.

Should this matter not be resolved satisfactorily, I reserve all my rights to escalate the complaint to senior management, the appropriate industry or regulatory ombudsman, and to pursue all remedies available to me as a consumer.

This matter requires urgent attention. I expect a substantive written response within a reasonable timeframe, detailing the findings of your investigation and the corrective action taken.
To further compound my concern, I recently added a newly adopted SPCA rescue pet to my policy in good faith, relying on the accuracy of the information provided by your representatives. I agreed to an additional premium of R560.00 per month with the understanding that this provided meaningful insurance cover. In total I now pay R825.66 a month and am now deeply concerned that I may face the same situation should treatment be required for my next baby.(Pet Cookie)

I want to strongly advise that I am that one customer that have always praised the service and speed that I got feedback and service from One Plan for my Pet.

Now I am not that customer anymore.
I wait your reply.

Company: HELLOPETER.COM
Country: South Africa
Region: Gauteng
City: Johannesburg
Address: Aloe place 1, unit nr 86
Phone: 0780360319
Site: www.hellopeter.com

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