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, a successor in title, beneficiary, life insured or premium payer 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 office.

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.

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