One of the country’s leading insurance companies has been reported to the National Financial Ombud Scheme South Africa (NFOSA) over allegations that it rejected a 42-year-old man’s claim by falsely citing that he has HIV and other deadly diseases.
Sam Khoza of Pretoria West said the company, which is known to Sunday World, left him and his family traumatised and nearly cost him his marriage. “My wife questioned me when I told her what the policy was claiming. My daughter got depressed, and I nearly lost my marriage because of these lies.
“I felt so uncertain about life. I had lost hope in everything. I believe this is a scam. I was paying for nothing, but I am happy that all these things are happening while I am still alive. My family would not have had the energy to take this up with them,” Khoza told Sunday World.
Detailing his account, Khoza said he took up the company’s offer for a life insurance policy in September 2023 after they contacted him telephonically.
He said the offer was good because it included occupational disability claims.
Last August, a doctor informed him that he may never be able to walk again due to a spinal cord condition.
He said he then remembered that his life cover policy also covers people with his condition. Khoza, who is a professional social worker and therapist, said that when he was told that his claim was valid, he was relieved until the insurance company told him that, after their investigations, they discovered he had not disclosed his medical history. He said when he enquired what they were referring to, he got the shock of his life.
“I am extremely hurt by such a flawed assessment of my claim. They say their investigations revealed that I am HIV positive, have a damaged liver, have kidney failure, have been admitted to a ward for persons living with HIV, and have been to two public health institutions that are situated in places that I have not been to,” Khoza said.
Khoza said that after agreeing to take up the policy from the company in 2023, the insurance company sent a nurse to come to his place and take a blood sample.
“They were checking if I had HIV. After a week, they called and said they did not find any chronic issues with me and that I was now covered. The question now is why did they send a nurse to take my blood and tell me that I am not HIV positive, just to wait for me to claim and be told the opposite?,”
Khoza was diagnosed with spinal tuberculosis 20 years ago, and as a result, he was wheelchair-bound for a year. He said this was a condition that he had fully recovered from. He said he told the insurance company about his fully recovered condition, and they approved him.
Last year, he started collapsing at work, and that is when he learnt from his doctor that he might not be able to walk again.
“They (insurance company) say there is a file somewhere in Mpumalanga and KwaZulu-Natal that was created in a hospital with my medical history. I asked myself how the file was created. What is the file’s number? If there were a person who shared the same name as me, the insurance could have been verified, especially after I told them I do not have those illnesses,” he said.
Sunday World has seen a claim rejection letter addressed to Khoza. In the letter dated February 4, 2025, the company said they declined his occupation-based disability claim as they were unable to consider the dread disease claim. The letter stated that, as per their policy book, full disclosure of all medical conditions was requested during the policy application.
The company stated in the letter that laboratory results received from the national health services confirmed blood tests that Khoza was HIV positive. “Had you disclosed the aforementioned conditions, [the company] would not have accepted the risk… therefore, your product has been reduced to an accidental death benefit only.”
The company told Sunday World it needed Khoza, who is the complainant in the matter, to give it his consent before commenting. An arrangement for a conference call with Khoza and the insurance company was made, but no one was available for the conversation.
Priya Rajah from NFOSA’s shared services department promised to provide feedback at a later stage. “The request has been sent to the team that specialises in life insurance complaints. We will provide our feedback soonest,” she said.
In an affidavit signed at Hercules Police Station dated February 12, Khoza declares that the information supplied by the company that he is HIV positive and has kidney failure and a damaged liver are untrue.
He challenged it to provide the customer call recording, saying it would reveal he did not hide any medical information.
Such a well-written piece. It kept me engaged from start to finish.