“Know your ombud” episode 6

In the latest episode of our Know Your Ombud series, I am joined by Sonya Marais, Senior Adjudicator for the Life Insurance Division of the National Financial Ombud (NFO), who helps us understand the complexities of long-term insurance.

Navigating the world of long-term insurance can be daunting, especially when it comes to understanding your rights as a consumer.

In this episode, Sonya and I discuss the various types of complaints that the ombud receives, including issues of non-disclosure and the ambiguity surrounding definitions of disability.

Many consumers are unaware that the advice they receive from brokers can significantly impact their claims. Often, they may not disclose essential information, leading to claims being denied.

Sonya highlights that while non-disclosure cases only accounted for about 5% of complaints last year, they can create significant challenges for consumers.

The episode also explores real case studies, illustrating how the ombud adjudicates complaints.

One case involved a driver who lost most of his eyesight and was denied a disability claim because the insurer’s definition of disability required him to be able to perform any occupation, not just his previous job.

Sonya explains the nuances of these definitions and how they can lead to unfair outcomes for policyholders, especially when they are not fully informed about the terms of their policies.

Moreover, Sonya discusses the importance of understanding employee benefits and the common pitfalls that employers and employees encounter. Many believe that having disability cover guarantees protection, but the actual terms can vary widely. This misunderstanding can leave individuals vulnerable when they need support the most.

Another critical topic is funeral policies, where issues often arise regarding insurable interest and the legitimacy of beneficiaries.

Sonya emphasises the need for consumers to be educated about who can be insured and the implications of cultural definitions of family.

The conversation reinforces the vital role of the ombud in providing a free service to consumers who feel wronged by financial institutions. By lodging a complaint with the ombud, individuals can seek resolution without the need for legal representation, a significant advantage that many may overlook.

In summary, this episode not only highlights the importance of understanding your rights but also provides practical insights into how the ombud can assist in resolving disputes.

Contact details

If you feel let down by a financial service provider, you can contact the appropriate ombud scheme via the links below:

• Ombud for Financial Services Providers (FAIS Ombud): Disputes related to financial advice
• Office of the Pension Funds Adjudicator (OPFA): Disputes related to pension funds
• JSE Ombud: Disputes related to the JSE
• National Financial Ombud Scheme (NFO): Disputes related to banking, credit, and insurance

This podcast series was created in partnership with The Ombud Council.