Call: 0860 103 236

For up to date information about the pandemic visit www.sacoronavirus.co.za

Please select an appropriate category from the list below or search for topics and cases using the search tool. Please type in the "CR" prefix when searching by case codes.

Sub Categories

CR180 Delay- group funeral scheme

CR180 Delay- group funeral scheme- late submission- exceptional circumstances that can be taken into consideration for late submission- equity considerations Background The complainant submitted a claim for his deceased wife a year and a half after the event. The insurer declined the claim on the basis that the policy document makes provision for a claim […]

Read More

CR179 Delay – late notification of complaint

CR179 Delay – late notification of complaint Background Occasionally the Ombudsman receives complaints where the act or omission giving rise to the complaint occurred many years before. In the majority of such cases prescription applies. In addition the Ombudsman’s Rules feature a qualifying time bar. Rule 2.3.3 reads:- “The Ombudsman shall not consider a complaint […]

Read More

CR178 Delay – late submission of claim – equity jurisdiction

CR178 Delay – late submission of claim – equity jurisdiction – funeral insurance Background The deceased, who died on 11 November 2004, was the policyholder and life insured of a policy offering funeral cover for R10 000. The policy stated: “Upon the death of any person insured under the policy, notice of the claim together […]

Read More

CR177 Delay – complainant instituting a claim against a policy after the surrender

CR177 Delay – complainant instituting a claim against a policy after the surrender/lapse of the policy concerned Background More or less the same point surfaced in two recent cases. In the first case the complainant’s policy offered life, accidental death and occupational disability cover. In June 2000 the complainant was shot and injured. In August […]

Read More

CR97 Compensation for late payment of death benefits caused by unjustified delay by an insurer.

CR97 Compensation for late payment of death benefits caused by unjustified delay by an insurer. Background Eleven years after the death of the deceased/policyholder, we received a complaint from a family member that the insurer insist that the claimants provide it with copies of the inquest record and blood samples before they would consider payment […]

Read More

CR66 Delay in transfer of funds from one insurer to another – who is liable for the loss?

CR66 Delay in transfer of funds from one insurer to another – who is liable for the loss? Background When the complainant retired in 1999 he bought a living annuity from Insurer A. In September 2002 he decided to convert the living annuity to a fixed interest annuity and contacted his brokerage. A meeting took […]

Read More

CR48 Onus of proof – life insured murdered – payment of proceeds to beneficiary delayed

CR48 Onus of proof - life insured murdered - payment of proceeds to beneficiary delayed Background The insured insured his own life for a substantial sum in favour of his wife. He was found murdered in his motor vehicle on a country road a considerable distance from his home. The insurer delayed payment of the [...]

Read More

CR17 Delay – exclusions – late submission of claim

CR17 • Delay – exclusions – late submission of claim – is the insurer entitled to rely on the exclusion clause? Mr A suffered a stroke on 29.07.2002. His doctor suggested that he wait “close to a year and only than (sic) it would be possible for him to say if damage is permanent or […]

Read More

Subscribe to our Newsletter