Complaints about long-term insurance policies
- The office for the Ombudsman for Long-term Insurance was established in 1985. The function of the office is to mediate in disputes between subscribing members of the long-term insurance industry and policyholders regarding insurance contracts.
- It is an independent office which is accountable to an independent Long-term Ombudsman Council for providing an efficient and independent service to policyholders and others in response to disputes arising from long-term insurance policies.
- Policyholders who submit a complaint to the Ombudsman may still decide to follow the conventional civil justice process, although these two processes are not allowed to proceed simultaneously.
- The service is free to complainants.
- Industry subscribers are bound by the Ombudsman’s rulings. There is provision in the rules for an informal appeal process.
In achieving its mission the office strives towards:
- ready access;
- cost effectiveness;
- speedy resolution of disputes;
- mediation rather than adjudication; and
- the right to afford due weight to equity.
Who can complain to us?
Any policyholder or any person with an interest in a policy issued by an insurer who subscribes to the Ombudsman scheme. If you are not sure if your insurer is a member, you can find out by telephoning the customer care line provided by your insurer or our offices.
What can you complain about?
We will accept complaints about:
- entering into of long-term insurance contracts; and
- their administration;
provided that the contracts were marketed or effected in South Africa.
We commonly receive complaints about:
- communication/administration failures;
- repudiations due to non-disclosure
- lapsed policies; and
- alleged unfair rejection of claims.