In November, 2021, CFTC received a complaint alleging unconscionable conduct against Wella Medical Aid Society (WEMAS).

 It was alleged that the complainant’s mother, who was under the medical insurance cover with the Respondent, got sick and died in September 2021 due to COVID-related complications.

The Complainant indicated that they had to make hastened funeral arrangements due to the nature of the death and undertook to pay for all costs relating to the hospitalization but also the funeral for the mother. The Complainant submitted a claim to the Respondent for the said costs. However, the Respondent did not process the claim indicating that they did not believe that all the claims made were genuine. The Commission found that the services accessed by the Complainant were performed and they made payments that the Respondent was supposed to refund under the medical scheme for which receipts had been provided.

Following deliberations, the Commission found the Respondent liable for unconscionable conduct and issued the following orders:

  • That r the Respondent should refund the Complainant the cost of medical services incurred during the hospitalization of the Complainant’s mother, in line with the terms and conditions of the medical insurance scheme. The refund should be in reference to the actual cost of MK403,487.00.
  • That the Respondent should refund to the Complainant the amount of MK1,000,000.00 being part amount paid towards funeral expenses for the Complainant’s mother.
  • That the Respondent should pay a fine of MK500,000.00 for engaging in unconscionable conduct.