What is the difference between ‘Mini Cases’, ‘Transfers’, ‘Reviews’ and ‘Full Cases?
These are simple complaints that are within the jurisdiction of the office but which insurers can handle without the office’s involvement. The complainant is always advised that if the matter is not resolved to his/her satisfaction, he/she can contact our office again.
These are complaints not previously seen by insurers which our office refers to them to try and resolve directly with the complainant.
If a transfer complaint is not resolved and if the complainant, when contacted by the office, requests us to do so, it is taken up by the office as a ‘Review’
These are complaints that have already been seen by insurers and they are handled by the office from inception to finalisation
What if I lodge a complaint with your office without going to the insurer first?
Complaints not previously seen by insurers are referred to them to try and resolve directly with the complainant. We refer to these complaints as ‘Transfers’. If not resolved and if the complainant, when contacted by the office, requests us to do so, they are taken up by the office as ‘Reviews’ and handled in the same manner as ‘Full Cases’.
When can I submit a complaint to your office?
You may submit a complaint to our office if you have raised the complaint with the insurer but the insurer has not been able to resolve the complaint to your satisfaction.
Must my complaint be in writing?
You can complain in writing but we also provide a telephonic or walk-in service.
What is the process of lodging a complaint with your office?
Complaints should preferably be lodged in writing to our office either via fax, post, email or through our online complaint submission form on our website Submit A Complaint. We also accept telephonic or walk-in complaints. The information we need from you is contained in the topic “How to Submit a Complaint”.
Can I lodge my complaint in my own language?
You may correspond with us in any of the official languages.
Does it cost anything to lodge a complaint?
No, the service is free to complainants.
If the service is free, how is the office funded?
We charge insurers a case fee for every case we handle. In addition insurers pay an annual levy.
Do you limit the insured amount claimed for?
No, we do not have a limit on the amount of the claim.
How long will my complaint take?
We acknowledge receipt of your complaint within one week. The investigation of your complaint will depend on its nature. Some complaints are resolved within a short period. Others can take some time to resolve. We will keep you advised of progress.
How long do you give the insurer to respond to my complaint?
We give insurers a 6 week response period for any first time complaints directed to them.
What may one complain about?
You can complain about the following:
- Where your claim has been declined;
- If you are dissatisfied with the policy performance and maturity values;
- Poor service;
- Lapsing of your policy;
- If you are dissatisfied with your surrender or paid-up values;
- Partial payment of claims;
- Credit Retrenchment insurance
What types of policies can I complain about?
We deal with life insurance / long-term insurance policies which provide:
- Annuities (but not retirement annuities);
- Life Insurance;
- Disability Insurance;
- Health Insurance;
- Funeral Insurance;
- Credit Life complaints;
- Hospital Plan Insurance;
- Dread disease Insurance.
Which complaints cannot be dealt with by your office?
- That are not against life insurers
- Financial advice or service by intermediaries
- Pension and provident funds, retirement annuities and preservation funds;
- Short-term insurance;
- Labour disputes;
- Medical Aid;
- Debt review, credit issues, ITC/blacklisting complaints.
Can I go to the press to complain while my complaint is under investigation with the Ombudsman?
No, we have a clause in our Rules that binds the parties to the complaint to confidentiality.
Must I still deal with the insurer once my complaint has been lodged with your office?
No, once a matter has been handed to our office, you should only correspond with us, unless we tell you otherwise.
However, if, after your complaint has been lodged with our office, we transfer it to the insurer to try and resolve, it is ok to deal directly with the insurer.
Must all correspondence about my complaint be sent to your office once my complaint has been received by your office?
Yes, and if you correspond with the insurer directly, we need to be copied with such correspondence.
Should or can I stop paying premiums while my complaint is being investigated?
No, you should carry on paying premiums unless the insurer has agreed that you can stop.
Can I submit more than one complaint?
Yes. Even if you have had a previous complaint resolved you can complain about a different matter.
How often will I get feedback regarding the status of my complaint?
We will acknowledge receipt of your complaint. Thereafter we will advise you of the status of your complaint when we have something new to report.
Can I assist or act on behalf of a friend or family member with their complaint?
Yes, but you will need to provide us with written permission from the person who is the complainant in the form of a signed mandate. A policyholder, beneficiary, life insured, premium payer or successor in title can be a complainant.
If you are the executor of an estate we need the letter of executorship.
Can your office give me financial advice?
No, we do not give financial advice. We resolve disputes.
What can I do if I am still not satisfied with the decision the Ombudsman's office has made?
The Office will always first make a provisional determination after its investigation. If you are not satisfied with it you can respond with your concerns and your complaint will then be re-assessed.
If you are still not satisfied after a final determination you can apply for leave to appeal in terms of the Rules.
Who carries the cost of medical reports or consultations which the insurer needs to assess my claim?
You have to pay for any medicals to prove your claim.
If the insurer wants to rely on an exclusion clause in the policy, the cost for any additional medical reports has to be paid by the insurer.
Will my complaint be treated as confidential?
All correspondence we receive is treated confidentially and shared only between the complainant, the insurer and our office. If we need an expert opinion we will share information with the expert.