Ombud upholds Sanlam complaint

THE Ombudsman for long-term insurance has upheld a complaint against financial services provider Sanlam for requesting frequent reports to support a claim for income disability benefits as it found that an annual review would have been reasonable.

In a statement, the Ombudsman’s office said the insured, Mrs D, who suffered from peripheral neuropathy, hypertension, asthma, reflux and bipolar disorder, had complained about numerous medical reports that were requested by Sanlam.

She found it distressing and unnecessary to provide reports so frequently.

In a provisional determination by the Ombudsman, Sanlam was found to only be entitled to obtain one report from each of Mrs D’s treating specialists annually.

In response to the finding, Sanlam said its request for regular medical reports enabled it to “consider the continuation of regular income payments for a client”.

“In this case, the Ombudsman confirmed our right to request these reports, but determined that it should not be asked more regularly than annually.

“The Ombudsman confirmed that more frequent requests may again be considered should there be an improvement in the client’s condition,” it said.

“Every email from Liberty is sent by a different person Ms W Complainant

In a separate matter, the Ombudsman also ordered Liberty to pay R15 000 as compensation for poor service in the handling of a claim by a woman who had two mastectomies and treatment for breast cancer.

Ms W had, in December 2018, written to the Ombudsman complaining that Liberty had refused to give her a copy of an occupational therapist’s report as she wanted to understand how she could improve her mental impairment.

After the complaint was lodged with the Ombudsman, the report was provided to Ms W.

The Ombudsman said in March 2019, Ms W had a second mastectomy, and again wrote to the Ombudsman complaining that she had issues with Liberty’s complaints department which did not respond to her many emails and telephone calls.

“They’ve now asked for detailed oncologist and psychologist reports although neither of these doctors were involved in the recent major surgery.

“Every email from Liberty is sent by a different person,” she said.

The Ombudsman said a provisional determination ordered R15 000 in compensation must be paid to Mrs W, and Liberty paid the amount.

Liberty yesterday said that “Liberty notes the statement by the Ombudsman for long-term Insurance and confirms that we have settled the client’s valid claim in full.

“We strive at all times to treat customers with the respect and dignity they deserve, and to go the extra mile for claimants.

“We acknowledge the poor service in dealing with the client on this matter, and accept that we should have done better.”