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.