Contact the Ombudsman for info on life cover disputes

As the owner of a life insurance policy it is important that you are aware of the existence of the office for the Ombudsman for Long-term Insurance. Established in 1985, the office serves to ‘mediate in disputes between subscribing members of the long-term insurance industry and policyholders regarding insurance contracts.’ Their website, www.ombud.co.za, contains a lot of useful information on life insurance disputes, including detail on:

• How to submit a complaint
• How to submit a dispute
• Common problems
• Helpful links
• Information brochures
• Contact details

The site also has a Fairness Checklist that explains your rights as a policyholder and lists a few useful self-help tips. This checklist reads as follows:
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.
• Only complete and accurate information is always required. (Remember that the information you supply to your life insurance provider when applying for life insurance or updating your policy is used to determine your premiums and benefit amounts. If you withhold information issues may arise when claims are submitted)
• If in doubt, disclose information. (If you are ever in doubt, always choose to disclose information to your life insurance provider as opposed to withholding it. Failure to do so may cause problems when you or your family try to claim against a policy)
• Always read any document before you sign it or if you purchase telephonically and are not sure about benefits or what you are buying, don’t hesitate to ask questions.
• Read through the policy contract to ensure that the documents conform to your expectations or what you understood the contract to be.
• Keep proof of your correspondence and dealings with the insurer and your intermediary.

If you ever have an issue with your life insurer that you cannot resolve, the office for the Ombudsman for Long-term Insurance is there to assist you. Their services are provided free of charge and you can contact them on 021 657 5000 or [email protected].

We hope you found this information on life insurance and the Ombudsman for Long-term Insurance useful.

We answer your questions about our products and services! 

How do I lodge a complaint against an insurance company in South Africa?

It is important that you try to solve your complaint with your specific insurer before going elsewhere. 1Life Insurance's complaints process can be found here.

If post this process you are still not satisfied with the outcome, you can lodge a complaint with the
National Financial Ombud Scheme South Africa NPC (the NFO)
Tel: 0860 800 900
Email: [email protected]
Website: www.nfosa.co.za

What does dispute mean in insurance?

An insurance dispute or disagreement occurs when the policyholder, beneficiary or member does not agree with the outcome of a claim or contractual terms and conditions as set out by the insurer.

What happens in an insurance dispute?

In a long-term insurance dispute, the resolution process typically involves several steps:

1. Contact the Insurer: Initially, you should contact the insurer directly to discuss the issue.
2. Submit a Formal Complaint: If the response from the insurer is unsatisfactory, you can submit a formal complaint to them and allow for the insurer to respond or provide further information. 
3. Approach the National Financial Ombud Scheme South Africa (the NFO): Should the dispute remain unresolved or unsatisfactory, you can take your complaint to the Ombudsman for Long-Term Insurance.
4. Provide Detailed Information: You’ll need to provide the NFO with all relevant communications, details and documentation related to your complaint.
5. Investigation: The NFO will investigate the matter and attempt to mediate a resolution.
6. Decision: If mediation fails, the NFO will make a decision based on the evidence, which is binding on the insurer but not on you, the policyholder.
7. Legal Action: If you’re still dissatisfied, the final step would be to pursue legal action against the insurer.
8. It’s important to note that this is a general process and specific steps may vary based on the jurisdiction and the insurance company’s policies. Always check the terms of your insurance policy and local laws for guidance.

How do I complain to the Ombudsman National Financial Ombud Scheme South Africa (NFO)?

You will need to contact the National Financial Ombud Scheme South Africa (NFO) after you have exhausted the complaints process with you insurer, you can then follow the complaints process as set up by the NFO

Does dispute mean you get your money back?

A dispute does not mean you will get your money back or that a decision will be changed, the dispute process provides for alternate options should you be unhappy with a decision or terms and conditions set out by your insurance provider