Topics and Cases

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Abusive Behaviour *

CR121 - Abusive behaviour Abusive behaviour - invoking Rule 3.3.2 (CR121)
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Accident *

CR170 - Accident Accident - whether an operation for cosmetic reasons resulting in death qualified as an accident as defined in the policy - causation (CR170)

See too:Exceptions, Exclusions And Waiting Periods*
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Advice *

CR171 - Advice Advice - intermediary - intermediary's obligation, if any, to furnish advice? (CR171)

See too:Intermediaries *, Misrepresentation *
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Agents

See too:Imputation Of Knowledge *, Intermediaries *
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AIDS/HIV

See too:Exceptions, Exclusions And Waiting Periods*
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Ambiguity

See too:Interpretation *
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Amendments To Policies

See too:Conclusion Of Contract *
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Annuities *

CR53 - Annuity Annuity lump sum of some R400 000 invested nil guarantee annuity payable monthly in arrears for life annuitant 57 years of age and in poor health at the time of its conclusion annuitant dies soon thereafter alleged misselling (CR53)
CR54 - Annuity Annuity- Pensioner offered option to purchase an annuity from insurance company - query concerning the commencement date (CR54)
CR122 - Annuity Annuity - complainant claiming annual increase in annuity payments (CR122)
CR172 - Annuity Annuity - time for determination of the amount : at time of death or claim? - procedure - rule 3.4.1 (CR172)
CR173 - Annuity Annuity - purchased with no escalation option - complainant queries non-escalation of monthly income - complainant alleges he was not a party to the agreement (CR173)
CR211 - Annuities Annuities - Complainants alleging that pension increases were inadequate (CR211)
CR212 - Annuities Annuities - Complainant contending that his pension increase was inadequate (CR212)
CR256 - Annuity Annuity - annual increases dependent on declared bonuses - whether insurer used its discretion properly in declaring bonuses - applicability of Promotion of Access to Information Act, no 2 of 2000 - whether insurer may unilaterally change policy from one portfolio to another (CR256)
CR297 - Quotations provided for joint life annuities Quotations provided for joint life annuities - applications completed without details of second life assured - single life annuities issued - duty on insurer to compare applications with quotations (CR297)

See too:Living Annuities , Retirement Annuities *
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Anti-Selection

See too:Exceptions, Exclusions And Waiting Periods*, Non-Disclosure *
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Appeals *

CR296 - Telesale of credit life policy Telesale of credit life policy - sales agent representing retrenchment benefit to be full amount owing on credit card - policy providing for a limited benefit- Appeal Tribunal ruling that insurer to be held to the representation (CR296)
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Back-To-Back Contracts
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Beneficiary Nominations *

CR174 - Beneficiary nominations Beneficiary nominations - nomination revocable - policyholder died before maturity of policy - executor ceded policy to one of the beneficiaries who obtained payment - rights of other beneficiary (CR174)
CR213 - Beneficiary nomination Beneficiary nomination - living annuity - on death of annuitant insurer must adhere to nomination Beneficiary nomination - living annuity - on death of annuitant insurer must adhere to nomination (CR213)
CR214 - Beneficiary nominations Beneficiary nominations - splitting of beneficiary nomination - policyholder nominates his two daughters and himself in predetermined proportions - validity of (CR214)
CR236 - Beneficiary nominations Beneficiary nominations - Two beneficiaries nominated on funeral policy - after death insurer paid full sum assured to one of the beneficiaries, relying on clause giving insurer a discretion to pay whomever it considered entitled to it - held, however, that the discretion had to be exercised reasonably, and could not ignore contractual entitlement (CR236)
CR237 - Beneficiary Nominations Beneficiary Nominations - Insured's nomination of beneficiary refused by insurer - remedies of disappointed beneficiary (CR237)
CR254 - Beneficiary nomination Beneficiary nomination - Insured's nomination of beneficiary refused by insurer-remedies of disappointed beneficiary (CR254)
CR274 - Joint life policy Joint life policy - spouses being joint policyholders - legal position when no beneficiary nominated and one of the policyholders dies (CR274)
CR298 - Insured married in community of property - Insured married in community of property - beneficiary nominated without consent of spouse - effect of section 15 of the Matrimonial Property Act (CR298)

See too:Funeral Insurance *
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Black Hole Policies
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Buy And Sell Arrangements
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Cancellations

See too:Lapsing *
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Capital Gains Tax

See too:Tax
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Causation *

CR175 - Causation Causation - exclusion - benefits not payable during "sickness attributable to pregnancy" - whether infection by a bacterium most probably introduced during procedures related to pregnancy is a basis for reliance on the particular exclusion (CR175)
CR299 - Exclusion clause Exclusion clause - was the insurer entitled to rely on it? (CR299)
CR300 - Exclusion clause Exclusion clause - was the insurer entitled to rely on it? (CR300)
CR308 - Exclusion clause Exclusion clause - requiring that the claim event must be "as a consequence of" the pre-existing condition - must therefore be the proximate cause - meaning of (CR308)
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Cession *

CR1 - Cession Cession - security cession - surrender by cessionary (CR1)
CR2 - Cession security Cession security - cession to bank does not extinguish the rights (CR2)
CR3 - Cession Cession - security cession - fraudulent surrender of policy (CR3)
CR4 - Cession Cession - effect of cession on rights of nominated beneficiary (CR4)
CR5 - Cession Cession - policy procured with a view to securing a bond (CR5)
CR6 - Cession Cession - sale of second-hand policies (CR6)
CR7 - Annuity Annuity - non-disclosure by insurer at point of sale (CR7)
CR55 - Cession Cession - security cession - policy ceded to bank to secure a bond - policyholder informs insurer that bond had been repaid and applies for a surrender of the policy - insurer demands proof that the policy had been receded to the policyholder - insurer continues, notwithstanding the notification, to deduct premiums from the surrender value of the policy (CR55)
CR56 - Cession Cession - security cession to bank - bank wrongly instructs insurer to surrender the policy - insurer not to blame for giving effect to the instructions - complaint referred to the Ombudsman for Banking Services (CR56)
CR57 - Sessie Sessie - bedrog - polis op 'n bedrieglike wyse deur werknemer van die versekeraar aan homself gesedeer - lening teen die polis - restitusie (CR57)
CR58 - Cession of insurance policy as security for a debt to a bank Cession of insurance policy as security for a debt to a bank - bank redeemed debt - insurer erroneously overpaid the bank as cessionary which credited the account of the insured with the excess payment - question whether insured was unjustly enriched at the expense of the insurer or the bank (CR58)
CR119 - Cession Cession - claim by cessionary - duty of insurer as debtor - buy and sell arrangement (CR119)
CR123 - Cession of policy to third party Cession of policy to third party - policy to revert to policyholder after five years - insurer ignores the term of which it was aware (CR123)
CR124 - Security cession Security cession - policy converted to paid-up without notice to the cessionary- reinstatement of the policy (CR124)
CR125 - Cession in securitatem debiti Cession in securitatem debiti - rights of cessionary to apply for the surrender of the policy (CR125)
CR126 - Cession Cession - security cession to secure repayment of instalments under a motor vehicle sale agreement - secured debt repaid - whether the insurer entitled to demand proof of redemption thereof (CR126)
CR127 - Cession in securitatem debiti Cession in securitatem debiti - who is to enquire about an alleged phantom cession (CR127)
CR128 - Bad service Bad service - compensation (CR128)
CR129 - Funeral insurance Funeral insurance - non-conclusion of contract - estoppel - compensation (CR129)
CR238 - Cession of Policy Cession of Policy - Cession of policy to bank in securitatem debiti - by virtue of cession, bank took a loan from the insurer in the name of the insured -invalidity of such loan (CR238)
CR257 - Cession Cession - of life policy after sequestration of insured's estate - to what extent policy protected against creditors of the insured in terms of section 63 of the Act (CR257)
CR301 - Cedent married in community of property failing to obtain spouse's consent Cedent married in community of property failing to obtain spouse's consent - cession in ordinary course of business - effect of section 15 of the Matrimonial Property Act (CR301)
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Churning

See too:Misselling *
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Code On Complaints Resolution
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Commencement Of Policy And/Or Risk
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Commissions

See too:Costs *
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Compensatory Awards
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Conclusion Of Contract *

CR8 - Conclusion of contract Conclusion of contract - telemarketing (CR8)
CR9 - Conclusion of contract of insurance Conclusion of contract of insurance - intermediary (CR9)
CR10 - Conclusion of Contract Conclusion of Contract - mistake (CR10)
CR17 - Delay Delay - exclusions - late submission of claim (CR17)
CR59 - Contract Contract - breach of mandate - entitlement to damages (CR59)
CR60 - Contract Contract - amendment of terms - unilateral change of contract by insurer - whether unreasonable (CR60)
CR61 - Offer to replace Offer to replace existing Life assurance policies by new policies - intention to terminate two original policies but premiums still collected - allegation that the two original policies were still in existence \(CR61)
CR130 - Conclusion of contract Conclusion of contract - Insurer acting on the unauthorised instructions of an adviser to alter the inception date of a policy (CR130)
CR131 - Conclusion of contract Conclusion of contract - cancellation and replacement of - "snatching at the bargain" (CR131)
CR302 - Reliance theory Reliance theory - credit life policy covering bond - insured relying on information provided by insurer to bank that cover in place - such information in turn furnished by bank to insured - no cover in fact granted (CR302)
CR297 - Quotations provided for joint life annuities Quotations provided for joint life annuities - applications completed without details of second life assured - single life annuities issued - duty on insurer to compare applications with quotations (CR297)
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Confidentially
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Constitution
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Consumer Protection

See too:Policyholder Protection Rules *
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Contra Proferentem Rule

See too:Interpretation *
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Cooling-Off Period
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Costs *

CR215 - Costs Costs - Complainant unhappy with return on his policies; alleging values diminished by surrender penalties (CR215)
CR62 - RA policy made paid-up RA policy made paid-up - Costs deducted (CR62)
CR63 - RA policies made paid-up Costs deducted
CR64 - Deduction of penalty Deduction of penalty - No contractual provision (CR64)
CR65 - Costs Costs - Alleged failure of broker to explain costs and commission structure - whether deductions on calculation of surrender value authorised by policy - error in calculation of surrender value uncovered (CR65)

See too:Commissions
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Credit Insurance *

CR239 - Credit insurance Credit insurance - Claim under credit life policy for redundancy benefit - meaning of redundancy in policy (CR239)
CR303 - Interpretation Interpretation - Claim under credit life policies for redundancy/retrenchment benefits - meaning of redundancy/retrenchment - insured lost his job when he did not meet sales targets (CR303)
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Damages *

CR66 - Delay in transfer of funds from one insurer to another Delay in transfer of funds from one insurer to another - Who is liable for the loss? (CR66)
CR67 - Transfer of funds from one insurer to another Transfer of funds from one insurer to another - Delay causing financial loss-damages (CR67)
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Deferred Compensation Schemes
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Delay *

CR177 - Delay Delay - Complainant instituting a claim against a policy after the surrender/lapse of the policy concerned (CR177)
CR178 - Delay Delay - Late submission of claim - equity jurisdiction - funeral insurance (CR178)
CR179 - Delay Delay - Late notification of complaint (CR179)
CR180 - Delay - group funeral scheme Delay - group funeral scheme - Late submission - exceptional circumstances that can be taken into consideration for late submission- equity considerations (CR180)

See too:Late Submission Of Claims *, Prescription / Time Bar *
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Disability *

CR11 - Disability claim Disability claim - Claim repudiated on basis of failure - (CR11)
CR12 - Disability claim Disability claim - Own similar or other occupation (CR12)
CR13 - Disability Claim Disability Claim - Total permanent disability (CR13)
CR14 - Disability claim Disability claim - Insurer being pedantic (CR14)
CR15 - Disability Disability - Suitable alternative occupation (CR15)
CR68 - Disability Disability - Whether claimant qualifies for a lump sum benefit (CR68)
CR69 - Disability claim Disability claim - Claimant involved in small scale catering operation - disability payments terminated (CR69)
CR70 - Disability Disability - Notification claim - contractual limitation of period within which insurer must be notified of "...any event which may give rise to a claim - circumstances under which it may not be reasonable for an insurer to rely on such a limitation (CR70)
CR71 - Disability Claim Disability Claim - Insurer declined on basis of alternative occupation - is the suggested alternative occupation reasonable? (CR71)
CR72 - Disability claim Disability claim - Whether complainant can be considered totally disabled if he is capable of performing a part-time occupation only (CR72)
CR73 - Disability claim Disability claim - Insurer's reliance on specialist's medical opinion in repudiating claim - whether the weight of evidence regarding the influence of impairment on the complainant's ability to work in accordance with the requirements of the definition had been properly taken into account (CR73)
CR74 - Disability claim Disability claim - Whether complainant could perform the material and substantial duties of his regular job (CR74)
CR75 - Disability premium waiver benefit Disability premium waiver benefit - Complainant shot in suspected hijacking - insurer insisting on annual review - not provided for in policy (CR75)
CR76 - Premium waiver benefit admitted and later terminated on review Premium waiver benefit admitted and later terminated on review - Whether cessation of benefit justified (CR76)
CR77 - Disability claim Disability claim - Repudiated on grounds that complainant capable of light physical and sedentary aspects of her employment - weight of expert evidence to the contrary (CR77)
CR78 - Interpretation of contract Interpretation of contract - Disability claim for permanent total disablement benefit - policy containing no definition of permanent total disablement (CR78)
CR132 - Disability Disability - Further medical examinations - onus (CR132)
CR133 - Disability - Notification of claim Disability - Notification of claim - Claimant's knowledge of cause of claim is prerequisite (CR133)
CR181 - Disability Disability cover at an advanced age (CR181)
CR216 - Disability - definition of disability Disability - definition of disability - Housewife as an occupation (CR216)
CR217 - Disability claim under credit life policy Disability claim under credit life policy - Insurer relying on pre-existing condition exclusion clause - was claimant aware of or ought reasonably to have been aware of the pre-existing condition? (CR217)
CR218 - Disability - income benefits terminated Disability - income benefits terminated - Policy cancelled - insured allegedly not taking prescribed medication (CR218)
CR219 - Disability claim - claimant possessed by ancestral spirit Disability claim - claimant possessed by ancestral spirit - Not following his own occupation - graduated as a sangoma - insurer of the view that the claimant (i) has not undergone optimal treatment and (ii) is not totally and permanently disabled as defined (CR219)
CR240 - Disability - Assessment Disability - Assessment - Occupation was 30% manual - complainant still able to perform most aspects of his occupation, but could not perform any manual work as result of permanent irreversible incapacity - settlement on basis that insurer would pay 50% of capital disability benefit assured (CR240)
CR258 - Disability - permanence of condition at issue Disability - permanence of condition at issue - When can a policyholder reasonably be expected to undergo surgery (CR258)
CR259 - Disability Disability - Insured running a business in which he contributed 70% labour - on becoming disabled he carried on with the business, but could only do so by employing people to do the manual work - nevertheless totally and permanently disabled - failure to notify insurer of change in occupation during currency of the policy - insurer thereby prejudiced (CR259)
CR275 - Total temporary disability Total temporary disability - Whether the complainant can be considered totally temporarily disabled from performing her own occupation if her problematic reactions are triggered mainly at her workplace (CR275)
CR276 - Disability Disability - Partial permanent incapacity claim declined by insurer on the merits of the case, as also on grounds of various technical defences, being late submission of claim, non-disclosure, termination of cover, and a policy requirement that the office considered could lead to an absurdity (CR276)
CR277 - Disability claim Disability claim - Complainant a mine shift boss suffering from epilepsy - whether capable of engaging in an alternative occupation for which he was or could reasonably be expected to become qualified - settlement (CR277)
CR286 - Disability claim rejected on grounds of late submission Disability claim rejected on grounds of late submission - Interpretation of contract - how to determine date of disability - claim subsequently repudiated on grounds that claimant no longer a member of scheme at date of disability - application of equity (CR286)
CR304 - Disability claim under credit life policy Disability claim under credit life policy - Complainant also member of pension fund - not disabled as defined in credit life policy, but disabled for purposes of pension fund (CR304)
CR316 - Prescription Prescription - Medical reports dealing only with complainant's condition many years later - prescription upheld (CR316)
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Disclosure

See too:Non-Disclosure *
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Dread Disease *

CR79 - Dread disease claim rejected Dread disease claim rejected - Catheterisation and angioplasty cannot be regarded as open-heart surgery (CR79)
CR182 - Dread disease benefit claim Dread disease benefit claim - Insurer refused claim, as condition did not qualify, but was only prepared to offer more life cover at substantially higher rates (CR182)
CR241 - Dread disease Dread disease - Complainant claiming for dread disease benefit on grounds of cancer - policy excluding "(a) all skin cancers, and (b) cancer-in-situ, including all melanomas-in-situ"- established that, while complainant's was not a cancer-in-situ or a melanoma-in-situ, the tumour had not spread beyond the skin and therefore remained a skin cancer; insurer's liability excluded (CR241)
CR250 - Dread Disease - Cancer Dread Disease - Cancer - Definition - is the insurer's interpretation of the definition too strict? (CR250)
CR251 - Dread disease claim Dread disease claim - Interpretation of contract - complainant making second claim in respect of dread disease benefit - insurer refusing to pay claim on ground that benefit cancelled after first claim - policy wording did not support this interpretation - if any ambiguity in policy, wording to be construed contra proferentem (CR251)
CR305 - Definition in relevant clause out of date Definition in relevant clause out of date - Strict application of it unfair and wasteful - application of equity - insurer's obligation to obtain necessary medical evidence (CR305)

See too:Disability *
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Education And Publicity
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Electronic Contracting
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Endownments

See too:Investment Policies *
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Equity *

CR242 - Equity Equity - Exception in policy covering disability - clause excluding intentionally or self induced illness or injury - insured donated one of her kidneys to save life of her brother - role of equity (CR242)
CR278 - Failure to apply for paid-up policy upon retirement Failure to apply for paid-up policy upon retirement - Insured unaware of the policy provision that he should make such application (CR278)
CR286 - Disability claim rejected on grounds of late submission Disability claim rejected on grounds of late submission - Interpretation of contract - how to determine date of disability - claim subsequently repudiated on grounds that claimant no longer a member of scheme at date of disability - application of equity (CR286)
CR305 - Definition in relevant clause out of date Definition in relevant clause out of date - Strict application of it unfair and wasteful - application of equity - insurer's obligation to obtain necessary medical evidence (CR305)
CR306 - Non-disclosure Non-disclosure - New policy issued as replacement - old policy cancelled - non-disclosure in application for new policy, and new policy cancelled - can claim be entertained on the replaced policy? (CR306)
CR307 - Group scheme Group scheme - Claim under group disability scheme repudiated on grounds of late submission - late submission policy provision in principle enforceable, unless considerations of equity demand otherwise - equity ruling not fair to insurer in the particular circumstances (CR307)
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Estoppel *

CR134 - Estoppel - double cession Estoppel - double cession- Policy ceded to a bank in securitatem debiti - insurer records the cession but by mistake informs the complainant, when he enquired, that no pre-existing cession was in place - complainant takes outright cession of the policy "as an investment" - whether the insurer is estopped from denying the legal effectiveness of the second cession (CR134)
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Evidence *

CR279 - Permanent incapacity benefit Permanent incapacity benefit - Insurer failing to advise at claim stage that enhanced benefit payable if disability caused by an accident - whether complainant prejudiced by insurer's failure - whether evidence proved on balance of probabilities that stroke due to accident - medical evidence (CR279)

See too:Onus Of Proof *
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Exceptions, Exclusions And Waiting Periods*

CR16 - Exclusions Exclusions - Fishing for info (CR16)
CR18 - Death claim Death claim - Rejected (CR18)
CR80 - Exclusion clause Is it applicable where circumstances surrounding cause of death unclear - onus on the insurer to prove.
CR81 - Uitsluiting Geen dekking in geval van wedrenaktiwiteite klaer ontevrede omdat hy sy betrokkenheid met wedrenne wel op aansoekdatum vermeld het.
CR82 - Accidental death benefit declined Deceased's concentration of alcohol in blood excessive - no causal link between concentration of alcohol and deceased's accidental death.
CR83 - Death claim - accidental death policy Death claim - accidental death policy - Whether the deceased negligently or intentionally exposed himself to danger; whether the death directly or indirectly arose from or could be traced to an action of the insured while his blood alcohol percentage was over the prescribed limit (CR83)
CR135 - Exceptions and Exclusions - suicide Exceptions and Exclusions - suicide - When is suicide suicide? (CR135)
CR176 - Exclusion - causation Exclusion - causation - Death resulting from pre-existing condition excluded - whether death was caused by the insured's pre-existing condition or by an intervening cause (CR176)
CR183 - Exclusion clause Exclusion clause - HIV diagnosis prior to commencement date but after application date (CR183)
CR210 - Waiting period - payment - funeral policy Waiting period - payment - funeral policy - failure to pay premium - lapsing of policy - fresh waiting period (CR210)
CR217 - Disability claim under credit life policy Disability claim under credit life policy - Insurer relying on pre-existing condition exclusion clause - was claimant aware of or ought reasonably to have been aware of the pre-existing condition? (CR217)
CR243 - Exceptions and exclusions Exceptions and exclusions - Pre-existing medical condition, lung cancer - whether later liver cancer could be termed as pre-existing (CR243)
CR244 - Exceptions - Exclusions Exceptions - Exclusions - Where death results from heart disease - whether heart attack necessarily results from heart disease (CR244)
CR245 - Exceptions and Exclusions Exceptions and Exclusions - Benefits excluded for hospitalisation - mental disease or disorder - an interpretation of the policy wording (CR245)
CR249 - Exclusion clause Exclusion clause - Is the insurer entitled to rely on the exclusion clause? (CR249)
CR252 - Exclusion clause - suicide - onus of proof Exclusion clause - suicide - onus of proof - Claim repudiated on insurer's presumption of suicide, based on post-mortem and police report - onus on insurer to prove suicide exclusion applied - insufficient evidence to prove suicide on a balance of probabilities - unreasonable in circumstances to await inquest report (CR252)
CR260 - Exception Exception - Exclusion clause - event arising from pregnancy - interpretation (CR260)
CR261 - Exclusion clause "any back condition" excluded - complainant sustaining a neck injury - neck injury not excluded.
CR299 - Exclusion clause Exclusion clause - was the insurer entitled to rely on it? (CR299)
CR300 - Exclusion clause Causation.
CR308 - Exclusion clause Causation - clause requiring that the claim event must be "as a consequence of" the pre-existing condition - must therefore be the proximate cause - meaning of.
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F.S.B
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Fairness

See too:Equity *
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Fais Act
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Fais Ombud
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Fraud
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FSOS Act
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Funeral Insurance *

CR19 - Funeral Funeral - Non-renewal of policy (CR19)
CR20 - Funeral Funeral - Potentially competing claimaint (CR20)
CR21 - Funeral Funeral - Competing claimants (CR21)
CR22 - Funeral Funeral - Confusion about identity (CR22)
CR23 - Funeral Funeral - Fraud by proposer (CR23)
CR24 - Funeral Funeral - Status of life assured (CR24)
CR25 - Funeral Funeral - Who is the correct claimant? (CR25)
CR26 - Funeral Funeral - Dubious claims (CR26)
CR27 - Funeral Funeral - Dubious claims 2 (CR27)
CR28 - Funeral Funeral - No underwriting change of premium (CR28)
CR29 - Funeral Funeral - Proof of claim (CR29)
CR84 - Funeral policy Funeral policy - Claim repudiated on basis that deceased did not fall within definition of "spouse" and complainant did not pay funeral costs - "common law spouse" - equity (CR84)
CR85 - Funeral policy Funeral policy- No consensus to conclude contract (CR85)
CR86 - Funeral Insurance Funeral Insurance - Nominated beneficiary - beneficiaries cannot be identified or traced (CR86)
CR87 - Funeral Policy Funeral Policy - Section 59 (2) of the Long-term Insurance Act, 1998 (CR87)
CR88 - Funeral Insurance Funeral Insurance - Principal life insured took out insurance cover on an extended family member as an additional life insured - principal life insured dies - within a month and during the grace period for the payment of premiums, the additional life insured also dies - whether cover under the policy ceases as a matter of law upon the death of the principal life insured (CR88)
CR89 - Funeral Policy Funeral Policy - Change of rules - waiting period (CR89)
CR90 - Non-payment on funeral plan Non-payment on funeral plan - Non-disclosure of material facts (CR90)
CR91 - Funeral Policy Funeral Policy - Increase in premiums - compensatory award (CR91)
CR92 - Funeral policy with accident cover Funeral policy with accident cover - Deceased insured died from unnatural causes - funeral claim paid but accident cover payment withheld (CR92)
CR93 - Funeral policy Funeral policy - Insurer's reliance on "maximum cover" provision (CR93)
CR94 - Funeral insurance Funeral insurance - Validity of funeral insurance policy (CR94)
CR95 - Funeral claim declined Funeral claim declined - Maximum age attained - not a full time student - accommodating attitude of insurer (CR95)
CR136 - Funeral insurance Funeral insurance - Insured life wrongly described as spouse of principal insured - agency - vicarious liability of insurer for agent's misrepresentation (CR136)
CR137 - Funeral Insurance - eligibility of policyholder Funeral Insurance - eligibility of policyholder - Whether disqualified because he did not belong to a particular trade union (CR137)
CR138 - Funeral policy Funeral policy - Section 53 of the Long-term Insurance Act No 52 of 1998 (CR138)
CR139 - Funeral Insurance Funeral Insurance - Increase of the rate of premiums alternatively the reduction of benefits at the discretion of the insurer (CR139)
CR140 - Funeral policy - principal life assured dies Funeral policy - principal life assured dies - Policy-owner dies before he can submit a claim - insurer pays proceeds to new policy-owner - should the insurer have paid the estate of the policy-owner or the new policy-owner (CR140)
CR141 - Fraud Fraud - Quite probable - but claim paid (CR141)
CR184 - Funeral insurance Funeral insurance - definition of dependent relative - brother-in-law (CR184)
CR185 - Funeral Insurance Funeral Insurance - what constitutes "dependant child"- can a student undergoing motor mechanic apprenticeship be regarded as a full-time student for purposes of the policy? (CR185)
CR220 - Funeral Insurance Funeral Insurance- Deceased working in medi-clinic – her death conceivably due to HIV exposure in the course of her duties – effect on co-life insured’s cover – whether policy could be made paid up – compensation for creating false expectation (CR220)
CR262 - Funeral policy Funeral policy - Covering "eligible children" as defined - interpretation - insurer liable, for interest as well (CR262)
CR263 - Funeral insurance policy Funeral insurance policy - Definition of a "common law spouse" - meaning of (CR263)
CR280 - Funeral benefit Funeral benefit - No beneficiary nominated by the policyholder - benefit paid to someone other than the executor of the deceased's estate (CR280)
CR281 - Funeral policy Funeral policy - Fund rule stipulating that a child over 22 years would only remain covered if he or she was a registered full-time student (CR281)
CR309 - Funeral Insurance Funeral Insurance - Insurer's practice to "deem" the life insured to be the policyholder, and not the person who applied in his or her own name for the policy - practice not justified (CR309)
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Good Faith
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Group Schemes *

CR278 - Failure to apply for paid-up policy upon retirement Failure to apply for paid-up policy upon retirement - Insured unaware of the policy provision that he should make such application (CR278)
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Guarantees
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Health Insurance *

CR142 - Disputed health insurance claim Disputed health insurance claim - Materials used in surgical procedure not covered (CR142)
CR143 - Health Insurance Health Insurance - Repudiation of claim on grounds of non-disclosure. Should the insured have disclosed a history of an eye problem particularly taking cognisance of the fact that a specific question featured in the application form (CR143)
CR186 - Health insurance Health insurance - Interpretation - "expenses reasonably and necessarily incurred" (CR186)
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Hearings *

CR96 - Dispute of facts not resolved Dispute of facts not resolved - Parties agree to a hearing of evidence in terms of Rule 5 point 3 (CR96)
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Illustrative Values

See too:Values *
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Imputation Of Knowledge *

CR30 - Imputation of knowledge Imputation of knowledge - Patent disability (CR30)
CR31 - Imputation of Knowledge Imputation of Knowledge - Dread disease claim submitted (CR31)
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Insolvency
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Insurable Interest *

CR187 - Insurable interest - "spouse" - divorce Insurable interest - "spouse" - divorce - Whether cover in respect of a "spouse" terminates, on the basis of absence of insurable interest, when that person no longer meets the requirements of a spouse as defined in the contract (CR187)
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Interest On Late Payments *

CR188 - Interest on late payment Interest on late payment - Delay of payment to nominated beneficiary caused by persons involved in the administration of the estate of the policyholder - whether steps taken by the insurer to locate the nominated beneficiary were reasonable? (CR188)
CR223 - Interest Interest - Complainant cancelled during the cooling-off (CR223)
CR282 - Insurer in mora - endowment policy Insurer in mora - endowment policy - Insurer's duty to take reasonable steps to find policyholder to make payment on maturity (CR282)
CR32 - Interest on late payments Interest on late payments - Funeral policy - late payment of benefit (CR32)
CR97 - Compensation for late payment of death benefits Compensation for late payment of death benefits - Caused by unjustified delay by an insurer (CR97)
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Intermediaries *

CR189 - Intermediary Intermediary - Delictual liability of insurer for representations made by an intermediary under the insurer's letterhead (CR189)

See too:Imputation Of Knowledge *, Misselling *
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Internal Ombudsman
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Interpretation *

CR33 - Interpretation Interpretation - Payment of a cancer claim (CR33)
CR34 - Interpretation Interpretation - Loan protection insurance (CR34)
CR98 - Ambiguity Ambiguity - In a policy wording (CR98)
CR222 - Interpretation Interpretation - Surgery performed not included in list of surgeries described in the policy - definition of "foreign body" (CR222)
CR264 - Interpretation - disability cover Interpretation - disability cover - Payable only if disablement occurs while in full time employment - meaning of (CR264)
CR265 - Interpretation - redundancy benefit Interpretation - redundancy benefit - Only payable if employed "full time" - meaning of (CR265)
CR266 - Interpretation Interpretation - Definition in policy of "accidental death" (CR266)
CR267 - Interpretation Interpretation - Ambiguity in policy terms - interpreted contra proferentem (CR267)
CR283 - Claim declined Claim declined - Policy covering cancer of the genitals including cervix, uterus, vagina and vulva - insurer contending that complainant's ovarian cancer not covered (CR283)
CR286 - Disability claim rejected on grounds of late submission Disability claim rejected on grounds of late submission - Interpretation of contract - how to determine date of disability - claim subsequently repudiated on grounds that claimant no longer a member of scheme at date of disability - application of equity (CR286)
CR303 - Meaning Meaning - Of redundancy / retrenchment (CR303)
CR310 - Termination of cover Termination of cover - Upon a policyholder 'ceasing to substantially practice his profession' as envisaged in policy provision (CR310)

See too:Ambiguity, Words And Phrases
Table1
Invalidity Of Policy
Table1
Investment Performance *

CR311 - Limitations Limitations - Of insurer's responsibility (CR311)

See too:Maturity *, Surrender *, Values *
Table1
Investment Policies *

CR99 - Investment instruction not carried out Investment instruction not carried out - Monies invested in second hand endowment policy - loss of capital (CR99)
CR100 - Investment - losses incurred from investment for elderly client Investment - losses incurred from investment for elderly client - Investment considered inappropriate - misselling - reinstatement recommended (CR100)

See too:Endownments
Table1
Jurisdiction *

CR35 - Jurisdiction Jurisdiction - if an investment product is wrapped (CR35)
CR36 - Jurisdiction Jurisdiction - lapsed policy (CR36)
CR101 - Jurisdiction - Exclusion clause Jurisdiction - Exclusion clause - Insurer alleges that it paid accident benefit in error - summons issued by insurer to prevent prescription - rules as they their read (CR101)
CR224 - Jurisdiction - death benefit payable to the deceased's estate Jurisdiction - death benefit payable to the deceased's estate - Father of deceased authorised by the Master of High Court to take control of deceased's assets listed in an accompanying inventory-benefits in respect of this policy not listed in the inventory - insurer paid benefit to deceased's father- Master, acting on behalf of deceased's minor children, asserts that the insurer should not have paid the benefit to the deceased's father - Master asserts that the insurer be ordered to repay the benefit into the Guardians Fund (CR224)
CR232 - Payment Payment - Insurer setting-off overpaid amount against other policy benefits (CR232)
CR268 - Jurisdiction Jurisdiction - Overpayment to the insured of her monthly pension-insurer demanding repayment - complainant lodging a complaint with the office - held: that the office has jurisdiction over the insurer's claim, a condictio indebiti - portion of the overpaid money ordered to be repaid (CR268)
CR312 - Mistaken payment by insurer to policyholder of portion of benefit Mistaken payment by insurer to policyholder of portion of benefit - Insurer in fact not liable because of an exclusion clause - complainant claiming balance of benefit - office's jurisdiction to deal at the same time with insurer's condictio indebiti as a counterclaim (CR312)
Table1
Keyman Policies *

CR102 - Key man insurance Key man insurance - Misrepresentation by life insured - materiality of undisclosed facts - return of premium (CR102)
Table1
Lapsing *

CR103 - Lapsing - interpretation Lapsing - interpretation - Life insured no longer eligible - reinstatement with full cover (CR103)
CR104 - Wanbetaling van premies Wanbetaling van premies - Verval van polis (CR104)
CR105 - Whole life policy made paid-up for reduced benefits Whole life policy made paid-up for reduced benefits - Policy kept in force until funds in the accumulation account were depleted - policy lapsed - complainant expected paid-up value to increase with bonuses (CR105)
CR253 - Lapsing of policy Lapsing of policy - Implications of acceptance of late payment (CR253)
CR255 - Lapsing of policy Lapsing of policy - Complainant repeatedly having failed to pay premiums - insurer always accepting double premiums thereafter - insurer held to have waived lapsing provision (CR255)
CR295 - Policy lapsing due to non-payment of premiums Policy lapsing due to non-payment of premiums when complainant in hospital for diabetes-related amputation - insurer initially refusing to reinstate, but later exercising its discretion in his favour - parties agreeing that arrear premiums be deducted from the sum assured at time of any claim - insurer waiving reliance on diabetes as pre-existing (CR295)
Table1
Late Submission Of Claims *

CR225 - Late submission Late submission (CR225)
CR226 - Late submission of claim Late submission of claim /Interpretation of contract (CR226)
CR284 - Equity Equity - unique circumstances (CR284)
CR285 - Death and disability Death and disability claims in terms of mortgage protection policies - individual policyholders, members of their employer's housing scheme, having been granted mortgage bond by their employer, ceding their policies to their employer - can the insurer be held liable where the employer fails to notify it of the claims within the periods set out in the policies? (CR285)
CR286 - Disability claim rejected on grounds of late submission Disability claim rejected on grounds of late submission - Interpretation of contract - how to determine date of disability - claim subsequently repudiated on grounds that claimant no longer a member of scheme at date of disability - application of equity (CR286)
CR307 - Group scheme Group scheme - claim under group disability scheme repudiated on grounds of late submission - late submission policy provision in principle enforceable, unless considerations of equity demand otherwise - equity ruling not fair to insurer in the particular circumstances (CR307)

See too:Delay *
Table1
Legal Practitioners

See too:Jurisdiction *
Table1
Legislation

See too:Fais Act , Pension Funds
Table1
Life Policies
Table1
Linked Products
Table1
Living Annuities

See too:Annuities *, Misselling *
Table1
LOA
Table1
Loading

See too:Premiums *, Rating By Exclusions
Table1
Loans *

CR144 - Loans Loans - loan against a policy - rate of interest left blank in application form - no subsequent agreement on rate of interest - validity of contract (CR144)
CR227 - Loan on security of policy Loan on security of policy - complainant alleges interest rate not disclosed (CR227)
CR246 - Loans Loans - Interest limit in terms of in duplum rule - loan on policy repaid in part - meaning in rule of "amount of unpaid loan" (CR246)
CR287 - Loan Loan - against policy as security - interest limit in terms of the in duplum rule - alternative remedies (CR287)
Table1
Long-Term Insurance Act
Table1
Mandate *

CR106 - Mandate Mandate - unauthorised investment - relief (CR106)
CR247 - Mandate Mandate - Misrepresentation by insurer that its financial adviser was independent - cancellation of contract of mandate (CR247)

See too:Agents, Misselling *
Table1
Marketing
Table1
Matrimonial Property Act *

CR298 - Beneficiary nomination Beneficiary nomination - insured married in community of property - beneficiary nominated without consent of spouse - effect of section 15 of the Matrimonial Property Act (CR298)
CR301 - Matrimonial Property Act Matrimonial Property Act- Cedent married in community of property failing to obtain spouse's consent - cession in ordinary course of business - effect of section 15 of the Matrimonial Property Act (CR301)
Table1
Maturity *

CR228 - Maturity Maturity - Policy open-ended after maturity date; whether complainant could rely on rate of interest quoted to him as applying throughout period until withdrawal of proceeds (CR228)

See too:Payment And Non-Payment *, Values *
Table1
Mediation
Table1
Medical

See too:Disability *
Table1
Minors *

CR224 - Jurisdiction - death benefit payable to the deceased's estate Jurisdiction - death benefit payable to the deceased's estate - Father of deceased authorised by the Master of High Court to take control of deceased's assets listed in an accompanying inventory-benefits in respect of this policy not listed in the inventory - insurer paid benefit to deceased's father- Master, acting on behalf of deceased's minor children, asserts that the insurer should not have paid the benefit to the deceased's father - Master asserts that the insurer be ordered to repay the benefit into the Guardians Fund (CR224)
CR288 - Payment to minor as policyholder Payment to minor as policyholder - policy contract rectified to reflect minor's guardian as the policyholder (CR288)
Table1
Misleading Marketing Material *

CR107 - Exaggerated marketing material Exaggerated marketing material (CR107)
CR145 - Misselling; misleading marketing material Misselling; misleading marketing material (CR145)
CR190 - Misleading marketing material Misleading marketing material - ‘n aantal onlangse gevalle uit die lêers van die Ombudsman vir Langtermynversekering (CR190)
CR191 - Misleading marketing practices Misleading marketing practices - "Education Plan" - refund of premiums - four variations on a common theme (CR191)

See too:Misselling *
Table1
Misrepresentation *

CR37 - Misrepresentation Misrepresentation - by independent broker prior to conclusion (CR37)
CR146 - Allegation of misrepresentation Allegation of misrepresentation concerning basic life cover - universal life policy - insurer neglecting duty imposed by policy (CR146)
CR147 - Misrepresentation Misrepresentation - offering of a conditional prize by insurer to proposer for insurance - effect on ensuing contract - section 45 of the LTIA (CR147)
CR192 - Misrepresentation Misrepresentation - insured wrongly informed by insurer's client service department that claim was covered - liability of insurer for post-contractual misrepresentation - compensatory award (CR192)
CR229 - Misrepresentation - Post Contractual Misrepresentation - Post Contractual (CR229)
CR230 - Misrepresentation Misrepresentation - Alleged misrepresentation; poor disclosure/poor service; optional cash withdrawal reducing sum assured (CR230)
CR296 - Misrepresentation - Telesale of credit life policy Telesale of credit life policy - sales agent representing retrenchment benefit to be full amount owing on credit card – policy providing for a limited benefit– Appeal Tribunal ruling that insurer to be held to the representation (CR296)

See too:Misselling *
Table1
Misselling *

CR108 - Onvanpaste advies Onvanpaste advies - belegging in die buitelandse mark - verhoor - remedie (CR108)
CR109 - Misselling Misselling - can insurer be held liable on the basis that the policy should never have been issued? (CR109)
CR110 - Misselling Misselling - The complainant alleges that she could never qualify for one of the benefits provided under the contract and that the policy was therefore incorrectly sold (CR110)
CR111 - All material facts not disclosed All material facts not disclosed - advice accordingly not appropriat (CR111)
CR112 - Misselling Misselling - Broker's inappropriate investment advise(CR112)
CR113 - Broker mismanaging insured's investment Broker mismanaging insured's investment - advice given by independent broker - several policies taken out and subsequently surrendered - recouping of loss occasioned thereby (CR113)
CR148 - Misselling Misselling - complainant alleges that she could never qualify for one of the benefits provided under the contract and that the policy was therefore incorrectly sold to her (CR148)
CR149 - Misseling Misseling - onvanpaste advies - belegging - lewende annuïteit - appèl (CR149)
CR150 - Misselling - complainant not uninformed Misselling - complainant not uninformed (CR150)
CR193 - Misselling Misselling - was advice by agent appropriate - was the investor's decision informed? (CR193)
CR194 - Misselling Misselling - client not needing RA proceeds at age 70 - adviser recommending two annuities, one funding life cover, the other a 15 year endowment (CR194)
CR39 - Misselling - instructions misunderstood Misselling - instructions misunderstood (CR39)
Table1
Mistake *

CR114 - Snatching at a bargain Snatching at a bargain (CR114)
CR151 - Mistake - snatching at the bargain Mistake - snatching at the bargain - bona fide error by insurer (CR151)
CR152 - Mistake - investment instruction not followed Mistake - investment instruction not followed - was the client's lack of action excusable (CR152)
CR195 - Mistake - settlement - Income plan (back to back) Mistake - settlement - Income plan (back to back) - insurer refusing at maturity date to pay value stated as minimum maturity value on endowment policy, alleging that the stated value was a reasonable mistake (iustus error), alternatively that the actual contract differed from that evidenced by the policy (CR195)
CR196 - Mistake - endowment portion of policy Mistake - endowment portion of policy; insurer refusing at maturity date to pay value stated as minimum maturity value on policy schedule, alleging that the stated value was a mistake (CR196)
CR197 - Mistake by the insurer Mistake by the insurer - enuring to the benefit of the complainant (CR197)
CR227 - Loan on security of policy Loan on security of policy - complainant alleges interest rate not disclosed (CR227)
CR248 - Mistake - Mistake by insurer when furnishing maturity values Mistake - Mistake by insurer when furnishing maturity values - insured attempting to take advantage of obvious error (CR248)
CR289 - Mistake excluding consensus - Mistake excluding consensus - insurer mistakenly imposing exclusion wording which did not conform to its intention - on the particular facts complainant could not reasonably rely on impression that insurer had not made a mistake - contract void ab initio and premiums refundable (CR289)

See too:Conclusion Of Contract *
Table1
Mitigation Of Loss
Table1
Mortgage Insurance
Table1
Negligence
Table1
Negligent Advice

See too:Misselling *
Table1
New Products
Table1
Non-Disclosure *

CR40 - Non-disclosure Non-disclosure - insurer's right to investigate (CR40)
CR41 - Non-disclosure Non-disclosure - what info is sufficient
CR42 - Non-disclosure Non-disclosure - extent of disclosure required
CR43 - Non-disclosure Non-disclosure - extent of duty
CR44 - Non-disclosure Non-disclosure - disability claim repudiated (CR44)
CR45 - Non-disclosure Non-disclosure - claim for disability repudiated - material
CR46 - Non-disclosure Non-disclosure - payment of claim for premium waiver benefit
CR115 - Repudiation due to alleged non-disclosure Repudiation due to alleged non-disclosure - was the non-disclosed material material? (CR115)
CR153 - Non-disclosure Non-disclosure - whether the insured disclosed sufficient information to have complied with his duty of disclosure (CR153)
CR154 - Non-disclosure Non-disclosure of material information. Proposer's mental status at the time non-disclosure featured is questioned (CR154)
CR155 - Non-disclosure Non-disclosure - whether evidence supported insurer's view that false information had been disclosed (CR155)
CR156 - Penalties Penalties – duty to inform policyholder of punitive deductions when making a loan against a policy – policyholder to be afforded a reasonable opportunity to make an informed decision about penalties charged (CR156)
CR157 - Non-disclosure Non-disclosure - exclusion - non-disclosure of suicide of other family members - passage of time - effect of (CR157)
CR198 - Non-disclosure Non-disclosure - whether evidence supported insurer's view that false information had been disclosed (CR198)
CR199 - Non-disclosure Non-disclosure - whether the insured disclosed sufficient information to have complied with his duty of disclosure (CR199)
CR200 - Non-disclosure Non-disclosure - materiality - remedies - may an insurer rescind if it would have contracted in any event albeit on different terms? (CR200)
CR231 - Non-disclosure Non-disclosure - Policy cancelled on grounds of non-disclosure- alleged re-instatement of policy after death of insured life - reinstatement abortive (CR231)
CR269 - Non-disclosure Non-disclosure - when knowledge of representative will be imputed to insurer - constructive knowledge -representative of insurer appointed to assist applicants for insurance in filling our proposals - thereafter to enter such information on an electronic form for assessment by underwriters - representative being told of a relevant condition but failing to enter it on electronic form (CR269)
CR270 - Non-disclosure Non-disclosure - complainant unaware of his condition - his doctor having failed to inform him thereof, and having further failed to disclose it in the medical certificate accompanying the proposal form (CR270)
CR271 - Non-disclosure Non-disclosure - bipolar mood disorder - dispute about whether diagnosed before inception of the policy - onus on insurer (CR271)
CR290 - Pre-existing conditions Pre-existing conditions - whether insured had failed to disclose relevant information (CR290)
CR291 - Complainant's refusal Complainant's refusal, after lodging his claim, to consent to the insurer obtaining a report from the specialist who had treated him - office unable to support the complainant (CR291)
CR306 - Equity Equity - new policy issued as replacement - old policy cancelled - non-disclosure in application for new policy, and new policy cancelled - can claim be entertained on the replaced policy (CR306)
CR313 - Claim for Disability Income Benefits- Claim for Disability Income Benefits- should a consultation during 2005 have been disclosed, and was it material to the risk (CR313)
Table1
Offer

See too:Conclusion Of Contract *
Table1
Ombudsman's Committee
Table1
Ombudsman's Council
Table1
Onus Of Proof *

CR158 - Onus of proof Onus of proof - pre-existing condition (CR158)
CR292 - Beneficiary having killed the life assured Beneficiary having killed the life assured - insurer raising defence that no-one can benefit from his or her own unlawful act - onus on insurer to prove that the killing was unlawful - State not proceeding with a prosecution - insurer not allowed to wait indefinitely (CR292)
CR48 - Onus of Proof Onus of Proof - life insured murdered (CR48)
Table1
Over-Insurance

See too:Insurable Interest *
Table1
Paid-Up Values *

CR201 - Paid-up value Paid-up value - informed decision (CR201)

See too:Costs *, Values *
Table1
Payment And Non-Payment *

CR116 - Funeral Insurance Funeral Insurance : A Perception from the Office of the Ombudsman (CR116)
CR202 - Payment - paid-up policies Payment - paid-up policies - Insurer failing to implement premium escalation by increasing annual debit order amount as specified in the contracts; policies falling into arrears and becoming paid-up; complainant unhappy with resultant maturity values (CR202)
CR203 - Payment - debit order not activated Payment - debit order not activated due to capturing error on part of insurer - policy lapsed (CR203)
CR204 - Payment of premiums Payment of premiums - debit order on third party's bank account without his authorisation - whether third party has a claim against the insurer for repayment of the premiums wrongfully deducted from his bank account - jurisdiction (CR204)
CR232 - Payment Payment - Insurer setting-off overpaid amount against other policy benefits (CR232)
CR232 - Payment Payment - insurer setting-off overpaid amount against other policy benefits (CR232)

See too:Lapsing *, Values *
Table1
Penalties *

CR159 - Penalties Penalties – duty to inform policyholder of punitive deducti ons when making a loan against a policy – policyholder to be afforded a reasonable opportunity to make an informed decision about penalties charged (CR159)

See too:Refund Of Premiums *
Table1
Pension Funds
Table1
Performance

See too:Investment Performance *
Table1
Policy Wording *

CR160 - Dread disease claim Policy Wording - Dread disease claim - heart attack definition not met (CR160)
CR161 - A cancer claim rejected Policy Wording - A cancer claim rejected (CR161)

See too:Interpretation *, Values *
Table1
Policyholder Protection Rules *

CR309 - Funeral Insurance Funeral Insurance - Insurer's practice to "deem" the life insured to be the policyholder, and not the person who applied in his or her own name for the policy - practice not justified (CR309)
Table1
Poor Service *

CR162 - Poor service Poor service - Insurer providing confidential policy information to a third party (CR162)
CR205 - Poor service - payment to incorrect party Poor service - payment to incorrect party (CR205)
CR293 - Administration of policies by insurer Administration of policies by insurer - insurer agreeing to change its practice to provide efficient service (CR293)

See too:Compensatory Awards
Table1
Pre-Existing Conditions *

CR294 - Hypertension and cholesterolaemia as causes of heart failure - proof Pre-Existing Conditions - Hypertension and cholesterolaemia as causes of heart failure - proof (CR294)
CR295 - Policy lapsing due to non-payment of premiums Policy lapsing due to non-payment of premiums when complainant in hospital for diabetes-related amputation - insurer initially refusing to reinstate, but later exercising its discretion in his favour - parties agreeing that arrear premiums be deducted from the sum assured at time of any claim - insurer waiving reliance on diabetes as pre-existing (CR295)
CR314 - Death Claim under credit life policy Death Claim under credit life policy - policy containing a pre-existing condition exclusion clause- was there any need for the proposer to undergo medical examination notwithstanding the aforesaid exclusion clause (CR314)

See too:Exceptions, Exclusions And Waiting Periods*
Table1
Premiums *

CR163 - Premiums - insurer waived premiums for two years Premiums - insurer waived premiums for two years - non activation by the insurer of debit order thereafter - insurer purported to cancel the policy and refused reinstatement (CR163)
CR272 - Premiums - group scheme - complainant leaving employment Premiums - group scheme - complainant leaving employment - policy ceded to complainant - complainant not being aware that further premiums required to be paid - insurer never having informed complainant thereof - policy lapsing - insurer failing to apply relevant term of the policy (CR272)
CR315 - Collected after cover ceasing Collected after cover ceasing - funeral cover ceasing at age 65 - member's premiums continuing, however, until her death at age 67 - death claim repudiated - complaint settled on basis that half claim paid, plus refund of premiums after age 65 (CR315)

See too:Lapsing *, Refund Of Premiums *
Table1
Prescription / Time Bar *

CR316 - Disability claim lodged 9 years late Disability claim lodged 9 years late - no up-to-date medical reports - prescription upheld (CR316)

See too:Delay *, Late Submission Of Claims *
Table1
Procedural Matters
Table1
Proof Of Claims

See too:Evidence *, Onus Of Proof *, Procedural Matters
Table1
Quotations

See too:Conclusion Of Contract *
Table1
Rating By Exclusions

See too:Exceptions, Exclusions And Waiting Periods*
Table1
Rectification *

CR234 - Rectification - justus error Rectification - justus error (CR234)
Table1
Refund Of Premiums *

CR49 - Refund of premiums Refund of premiums - cancellation of contract by insurer (CR49)
CR165 - Refund of premiums Refund of premiums - non-disclosure of material facts - contract rescinded - premiums forfeited in terms of a penalty clause - reduction of penalty - nterest on premiums (CR165)
Table1
Reinstatement Of Policies Or Benefits *

CR117 - Advances made to third parties against an insurance policy without the knowledge or consent Advances made to third parties against an insurance policy without the knowledge or consent of insured - insured's demand to insurer to reinstate value of policy as if advances not made (CR117)
CR206 - Reinstatement of policy Reinstatement of policy - poor service - policy wrongly terminated - provisions not allowing insurer's action (CR206)
CR295 - Policy lapsing due to non-payment of premiums Policy lapsing due to non-payment of premiums when complainant in hospital for diabetes-related amputation - insurer initially refusing to reinstate, but later exercising its discretion in his favour - parties agreeing that arrear premiums be deducted from the sum assured at time of any claim - insurer waiving reliance on diabetes as pre-existing (CR295)
Table1
Remedies And Relief
Table1
Reopening Of Closed Cases
Table1
Res Judicata; Reopening Of Closed Cases

See too:Reopening Of Closed Cases
Table1
Rescission *

CR50 - Rescission - partial - claim for disability Rescission - partial - claim for disability (CR50)
CR51 - Rescission - claim for disability benefit Rescission - claim for disability benefit (CR51)
Table1
Retirement Annuities *

CR118 - Retirement annuity policy Retirement annuity policy - surrender of policy on basis of incorrect quotation of surrender value - reasonable reliance (CR118)
Table1
Review
Table1
Rules Of The Ombudsman
Table1
Sale Of Insurers Business *

CR317 - Sale of insurer’s business Sale of insurer’s business - Insurer selling off portions of its business to various other insurers - paid-up cover - which insurer responsible (CR317)
Table1
Sale Of Second-Hand Policies

See too:Cession *
Table1
Scams

See too:Fraud
Table1
Second-Hand Endowment Policies

See too:Cession *
Table1
Settlements *

CR207 - Settlement - by conduct Settlement - by conduct (CR207)
CR208 - Settlement by insurer Settlement by insurer - confidentiality - unforeseen negative spin-off of a generous settlement (CR208)
Table1
Snatching At The Bargain
Table1
Statistics
Table1
Suicide

See too:Exceptions, Exclusions And Waiting Periods*
Table1
Surrender *

CR166 - Surrender Surrender - forged signature on surrender documents (CR166)
CR167 - Surrender - right of complainant to surrender a policy Surrender - right of complainant to surrender a policy - ownership of policy (CR167)
CR209 - Surrender Surrender - life cover reduced by approximately R200 000 due to part-surrender of the policy - policyholder alleges she was not made aware of the effect of the part-surrender on the policy (CR209)
CR235 - Surrender of policies - nature and requirements Surrender of policies - nature and requirements (CR235)
CR273 - Surrender - illustrative value grossly overstated by insurer Surrender - illustrative value grossly overstated by insurer - policyholder relying thereon to his prejudice - held that it must have been obvious to the policyholder that the overstated illustrative value had been a mistake- insurer not liable (CR273)

See too:Values *
Table1
Tax

See too:Capital Gains Tax
Table1
Telemarketing *

CR296 - Telesale of credit life policy Telesale of credit life policy - sales agent representing retrenchment benefit to be full amount owing on credit card - policy providing for a limited benefit- Appeal Tribunal ruling that insurer to be held to the representation (CR296)

See too:Conclusion Of Contract *, Misselling *
Table1
Termination Of Contract

See too:Lapsing *, Rescission *
Table1
Transfer of Policies

See too:Churning
Table1
Trusts
Table1
Underwriting
Table1
Universal Life Policies
Table1
Values *

CR52 - Values - surrender- wrong values quoted - estoppel Values - surrender- wrong values quoted - estoppel (CR52)
CR120 - Dissatisfaction with policy performance Dissatisfaction with policy performance (CR120)
CR168 - Values - renewal of contract on maturity Values - renewal of contract on maturity – options to be exercised by insured - reasonable reliance (CR168)
CR318 - Poor maturity values - systemic problems Poor maturity values - systemic problems - two cases, with different insurers, where the office's intervention led to increased benefits not only for individual complainants, but also other policyholders who had not complained (CR318)

See too:Illustrative Values , Paid-Up Values *, Payment And Non-Payment *, Surrender *
Table1
Waiting Periods *

CR210 - Waiting period - payment - funeral policy Waiting period - payment - funeral policy - failure to pay premium - lapsing of policy - fresh waiting period (CR210)
CR221 - Funeral Insurance - spouse - waiting period Funeral Insurance - spouse - waiting period (CR221)

See too:Exceptions, Exclusions And Waiting Periods*
Table1
Waiver *

CR169 - Waiver - non-disclosure- special offer to members of a medical aid scheme Waiver - non-disclosure- special offer to members of a medical aid scheme - risk to be assessed on the basis of medical records - whether insurer waived its right to a full disclosure of material facts (CR169)
Table1
Warranties
Table1
Words And Phrases

See too:Interpretation *

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