WHAT WE DO
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:
- informality;
- 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 of 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:
- marketing;
- 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;
- mis-selling;
- lapsed policies; and
- alleged unfair rejection of claims.
WHAT WE DO NOT DO
We cannot investigate complaints that involve the following:
- the conduct of intermediaries in respect of policies sold after 01/10/2004
- purely administrative issues such as cancelling a policy, etc;
- short-term insurance; and
- unit trusts or other investments.
- complaints that are the subject of legal proceedings, instituted by you