Download Attachments

  • pdf Case 15 – Payment of PHI benefit
    Payment of PHI claim after cessation of membership – fairness of insurer’s decision – insurer had incorrectly terminated PHI benefit
  • pdf Case 14 – Ceded policies surrendered
    Policies ceded on divorce to minor children – cedent subsequently surrendered policies – children (now majors) contesting surrender
  • pdf Case 13 - Late Submission of Group Scheme Funeral Benefit Claim
    Policy providing submission by nominee of claim within six months from date of death; late submission due to personal circumstances and policy unknown to nominee; insurer unable to show specific prejudice if claim admitted; exercise of equity jurisdiction
  • pdf Case 12 - Final Determination
    Policy providing that claims must be submitted within a stipulated time; complainant given 4 months sick leave to receive treatment; thereafter her condition deteriorated; finally, some nine months after the stipulated time had expired, doctors declared her permanently disabled; Ombudsman’s equity jurisdiction applied.

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