Insurance ombudsmen put 400 million rand back in the pockets of consumers…

Consumers received nearly R400 million last year from the Offices of the Ombudsman for Long Term Insurance and the Ombudsman for Short Term Insurance, with just under R1 million rands awarded by the short-term insurance ombudsman for poor service on the part of the insurers.

Speaking at the release of a joint annual report from the two offices for 2021, Denise Gabriels, the assistant ombudsman for long-term insurance, said her office had received a record 17,379 requests for assistance. written. Of these, 8,163 were found to be viable complaints and 7,533 cases were finalized.

A total of R200.7 million was recovered for the complainants in lump sums and an additional R948,592 was awarded to the complainants as compensation for poor service.

Gabriels attributed the increase in the number of complaints to the effects of the Covid-19 pandemic, as insurers widely reported the increase in the number of claims. She also noted that the increase in poor service was exacerbated by the conditions in which many insurers had staff working from home with difficulties related to accessing information and documentation.

Understandably, in a post-Covid environment, funeral and life insurance claims have increased, accounting for 45% and 11% of total complaints, respectively, while life insurance complaints have declined by 34%. % to 30% of total complaints and disability insurance complaints have slipped. 10% to 8% of total complaints.

Unreasonable behavior

Gabriel’s office has taken a strong stance on the unreasonable behavior of complainants and insurers over the past year. Although complainants are understandably upset and frustrated when they file a complaint with the Ombudsman’s office, there are now clear guidelines on what is acceptable and what will not be tolerated.

Complainants’ unreasonable behavior includes:

  • Dishonest, frivolous, vexatious, threatening and abusive behavior. Examples include offensive language, any form of discrimination, inflammatory statements and threats of violence, direct or veiled.
  • Unreasonable requests, such as insisting on a response or action other than in accordance with the usual complaints resolution process. This includes insisting on contacting a particular member of staff, despite that person’s unavailability or the fact that they may not be the appropriate person.
  • Excessive levels of contact, which include multiple letters and phone calls or office visits, especially when such communications do not follow the usual complaints resolution process.
  • Inappropriate social media activity.

The Office of the Ombudsman for Short-Term Insurance (Osti), on the other hand, fell short of two operational targets for the past year.

Chief Executive Edite Teixeira-McKinnon said her office had hoped to achieve an average complaint handling time of 120 days and ensure that the number of complaints pending for six months does not exceed 10% of the number of complaints. open. However, the office ended the year with an average processing time of 138 days and with 332 complaints pending for six months, down from 300.

The Osti office registered 9,797 new complaints, of which 259 were related to Covid-19 – 197 related to business interruption and 62 to travel insurance.

Complaints arising from civil unrest, looting and infrastructure damage in KwaZulu-Natal and Gauteng in July 2021 have been handled by the South African Special Risk Insurance Association (Sasria). A total of 31 Sasria complaints were registered last year, of which 23 related to commercial insurance and eight related to personal insurance.

The short-term insurance ombudsman ended 2021 with 3,052 open complaints, compared to 4,210 in 2020, the difference being mainly due to the 7% increase in complaints registered in 2020 and a drop of almost 12 % of complaints registered last year. DM/BM

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