Half Year Statistics – Ombudsman for Long-Term Insurance
9 Sep, 2022

Half Year Statistics – Ombudsman for Long-Term Insurance

Judge Ron McLaren, Ombudsman for Long-Term Insurance

HALF YEAR STATISTICS

The first half of 2022 has shown a decline of 11.8% in the number of chargeable complaints received compared with the same period last year, when the number of complaints reached a record high in the wake of the COVID-19 pandemic. However, it is still 30% higher than the number of chargeable complaints received in the first half of 2020. Despite the decline in chargeable complaints received, the number of written requests for assistance increased by 7.6%. We reply to each request for assistance and refer complaints not in our jurisdiction to the appropriate financial services ombud or direct the correspondent to the appropriate complaint resolution forum where possible.

A phenomenon which seems to be on the rise is the persistency of some complainants. Even after a final ruling has been issued and an application for appeal has been dealt with, some complainants persist with pursuing their complaint, often involving mainstream and social media. Some complainants send multiple communications in a short space of time and demand that their matter receives priority attention or that a specific adjudicator handles it. This impacts on our productivity and has resulted in several complainants being cautioned about our Rule 3.3.2 and Policy on Unreasonable Complainant Behaviour.

TYPES OF BENEFITS

Comment: There has been a slight decrease in complaints relating to Credit Life benefits, whereas issues relating to Funeral benefits continue to be the largest cause for complaints to our office.

Nature of complaints – closed cases:

Comment: There were no significant changes in the nature of complaints closed, compared to the same period last year. The percentage of complaints in the Lapsing category is still higher than pre-Covid years as policyholders struggle to pay premiums under very difficult economic circumstances and often cannot meet the requirements for reinstatement.

Cases closed Wholly or Partially (W/P) in favour of complainants

Transfers

Of the 3709 chargeable complaints received, 76.5% were Transfers. These are complaints that have not been dealt with by insurers and are referred to insurers so that they may try and resolve the complaints directly with the complainants.

Insurers settled 31% (872 complaints) of the Transfers directly with complainants, a similar percentage to the same period last year.

Like the same period last year, 29% (831) of the Transfers became Reviews i.e., Transfers that were not resolved and where the complainant wanted our further intervention. These complaints are then dealt with in the same manner as our Full Cases.

The balance of the Transfers either still await a response from the complainants/insurers or the complainants have not indicated that they require further action from the office after we contacted them.

For more information about the office and its activities, please visit our website: ,www.ombud.co.za

Third Floor, Sunclare Building, 21 Dreyer Street, Claremont, Cape Town, 7700
Private Bag X45, Claremont, Cape Town, 7735
(Sharecall) 086 010 3236
(T) +27 21 657 5000
(F) +27 21 674 0951
(E) info@ombud.co.za

Ombudsman Central Helpline: 0860OMBUDS / 0860 66 2837

Disclaimer:

This article is published for general guidance only. The information it contains reflects our policy position at the time of publication. This information is neither legal advice nor a definitive binding statement on any aspect of our approach and procedure. The case studies are based on actual complaints we have dealt with.

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