How the ombudsman for long-term insurance can help you

The ombudsman for long-term insurance mediates in disputes between members of the long-term insurance industry and policyholders. The service is free and the ombudsman helps to resolve disputes quickly, through mediation and with cost-effectiveness in mind.

When Thandi – not her real name – took out a funeral policy with Bonlife, a fund that is underwritten by Sekunjalo Life, she did so to cover herself and her father. When her father died, Bonlife declined to pay the funeral benefit, so Thandi approached the ombud, judge Brian Galgut

Galgut was unable to uphold her claim because her father had died before the commencement of his cover.

What occurred in the course of his investigation, however, was that there were undue delays in the response to questions posed by the ombudsman. In this regard, he wrote to Sekunjalo Life on March 8 2010 and sent reminders on March 30, April 14 and April 29.

On May 26, the ombudsman issued a provisional determination in terms of which Sekunjalo Life was ordered to pay compensation to Thandi in the amount of R1 000 for the distress and inconvenience its failure to respond had caused her.

Sekunjalo did not respond to the determination and on July 12 a final determination was issued, stating that the company had to pay the R1 000 to Thandi on or before July 26. Once again, the payment was not made, and on August 9 the ombudsman set a deadline of September 6.

In terms of the ombudsman’s rules, if the amount was not paid on or before that date, the ombudsman would publish the fact of Sekunjalo Life’s failure.

Payment was eventually made on September 15.

While Galgut could not assist Thandi in obtaining relief in terms of the cover, the failure to respond had caused Thandi distress and inconvenience for which compensation of R1 000 became payable to her by Sekunjalo Life.

How to complain to the ombudsman for long-term insurance
If you have an insurance complaint, follow these procedures:

  • Try to resolve the problem with your insurer first. If this fails, or you are not satisfied with the proposed resolution, contact the ombud.
  • Give the ombudsman your policy number(s) and insurance company contact details, as well as a summary of your complaint.
  • Provide copies of supporting documents and correspondence with your insurer.
  • People commonly complain about claims that are rejected, lapsed policies, misselling and communication or administration failures.
  • Contact the ombudsman on (021) 657 5000 or info@ombud.co.za

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