Organization : The Ombudsman For Long-Term Insurance
Service Name : Making a Complaint
Town : Claremont
Country: South Africa
Website : http://www.ombud.co.za/
Submit a Complaint: http://www.ombud.co.za/how-to-complain/submit-a-complaint
How to complain:
Contact your insurer first.Your insurer should be given the opportunity to resolve the problem or complaint before it is referred to the Ombudsman.
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Contact us if you are not satisfied with the response.
Requirements for complaints submitted to the Ombudsman
The complaint must be in writing, or with our assistance at telephone.
Please provide us with the following information:
** policy number/s;
** insurance company;
** policyholder contact details;
** factual summary of your complaint; and
** letter of mandate if you are writing on behalf of the policyholder or beneficiary.
Note:
** Keep the details of your complaint as short and factual as possible.
** Provide us with copies of supporting documents referred to in the complaint, including correspondence with the insurer.
** Please write neatly. Type if possible. Black ink should be used for faxed correspondence.
** A complaint can be submitted in the language of your choice
What happens next?:
** You will receive a letter of acknowledgement advising you about the line of action we intend to take.
** Should the complaint fall within the ambit of our rules, we will write to the insurer concerned requesting an investigation of the matter.
** The insurer is requested to respond within six weeks. On receipt of a written response the complaint will either be decided and the complainant advised accordingly or further information or comment might be requested from either or both parties.
Costs:
This is a service free of charge to the public.
The operating costs of the office are met by subscribing members of the long-term insurance industry.
Fairness Checklist:
The policyholder is entitled to the following:*
details of the intermediary and his/her relationship with the insurer. Insurers must mandate intermediaries for the products they sell;
details of the transaction with reference to expenses, assumptions, values, benefits, premiums, loading, guarantees, exclusions, etc;
information about the cooling-off period;
the implication of replacing one policy with another;
notification from the insurer that a policy has been cancelled; and
written explanation for repudiation or non-payment of claims.
*(Applicable to policies sold after 1 July 2001)
Self-help guide:
The policyholder has a 30-day grace period during which a policy or an amendment to a policy can be cancelled.
Always complete a proposal form for a policy yourself. Only in this way will you fully understand the nature of the information required.
Information sought is never a formality and complete and accurate information is always required.
If in doubt, disclose information.
Always read any document before you sign it.
Read through the policy contract to ensure that the documents conform to your expectations or what you understood the contract to be.
Keep written proof of your correspondence and dealings with the insurer and your intermediary.
Funeral Policy Hints:
There are many different kinds of funeral policies. Some are group policies, some are individual policies covering one life or extended families. These policies are sold in many different ways: directly to consumers by insurers, through sales people, or by banks or shops, or through membership of other organisations. Most funeral policies do not have any savings element, but some do. Some policies provide for a funeral service as the benefit. However, the policy must always also provide for a sum of money to be paid as an alternative to the funeral.
There are “scams” and illegal operators around. It is important that you deal with trustworthy organisations. Take your time and do not rush into a decision to buy a policy.
The Ombudsman for Long-term Insurance resolves disputes between subscribing insurers and policyholders. If you are not able to resolve a complaint with an insurer then you can write to us.
Our details are:
Postal Address: Private Bag X45, Claremont, 7735
Telephone No.: (021) 657 5000
Fax No.: (021) 674 0951
E-mail: info@ombud.co.za