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CR327 Jurisdiction Deceased employed by an insurer

CR327 Jurisdiction Deceased employed by an insurer – as such a member of its group scheme underwritten by the same insurer – on his death his life partner not satisfied with allocation by his employer of group scheme death benefit – office not having jurisdiction over a decision by the insurer in its capacity as […]

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CR312 Jurisdiction- Mistaken payment by insurer to policyholder of portion of benefit

Jurisdiction CR312 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. The following is a provisional determination issued by the Ombudsman. […]

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CR268 Jurisdiction – overpayment to the insured of her monthly pension

CR268 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. BACKGROUND The complainant’s husband had been in receipt of a pension […]

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CR224 Jurisdiction- death benefit payable to the deceased’s estate

CR224 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 […]

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CR101 Jurisdiction – Exclusion clause – insurer alleges that it paid accident benefit in error

CR101 Jurisdiction – Exclusion clause – insurer alleges that it paid accident benefit in error – summons issued by insurer to prevent prescription – rules as they their read. Background The insured “the deceased” died in a motor accident whereupon the insurer paid out an amount of R216 982 to the beneficiary partly as an […]

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CR36 Jurisdiction – lapsed policy – premium part of bond repayment

CR36 Facts The policyholder had taken out a bond from a bank.  The bank required a policy on the life of the house owner to be ceded to it as security. The premiums for the policy were included in the total bond payment made every month.  As interest rates vary this payment amount changes from [...]

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CR35 Jurisdiction – if an investment product is “wrapped”

CR35 Jurisdiction – if an investment product is “wrapped” in a life assurance policy any complaint would fall within the Ombudsman’s terms of reference Background Most major life assurance companies have associate organisations which are “in house” linked investment companies. This is an area where the Ombudsman’s jurisdiction is questionable but if a life assurance [...]

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