PROVISIONAL AND FINAL DETERMINATIONS

for the purpose of making a final determination. Says McLaren: “It is our experience that if a provisional ruling is made against an assurer and if it has no new evidence or submissions, the assurer nearly always accepts the office’s provisional ruling, despite the fact that it does not agree with it. In some instances, an assurer may expressly record its disagreement with a provisional ruling without formally challenging it.”

If an assurer challenges the correctness of a provisional ruling against it, a final determination may be made at a meeting of the office’s adjudicators. If a final determination is made against an assurer, the particulars thereof, including the name of the assurer, are published on the ombudsman’s website.

The office published two final determinations against assurers in 2016. In the first, it was held that adequate documents had been submitted to Bidvest Life to assess a claim, and it had not proved that it was entitled to rely on an alleged non-disclosure by the deceased or on the applicability of an exclusion clause.

The second determination, against Liberty Life, was resolved through the exercise by the office of its equity, or fairness, jurisdiction. In refusing a claim, Liberty relied on the late submission thereof. After considering the relevant facts, including the absence of any proof by Liberty that it would suffer prejudice in relation to the claim, it was decided that Liberty should process the claim.