OMBUD COMPLAINT STATISTICS

ACCORDING to the 2020 annual report of the Insurance Ombudsman, also released this week, the office of the ombud dealing with long-term insurance received 14 198 written requests for assistance last year (compared with 11 915 in 2019), which included 6 756 valid complaints. This is the highest number of written requests the office has ever received.

A total of 6 512 complaints were finalised. This includes 3 624 full cases in which the ombudsman intervened, and of these 31.73% were resolved wholly or partially in favour of complainants. Declined claims remained the biggest cause of complaints, with a slightly higher percentage (50%) of the total complaints than in 2019 (47%).

The ombud’s office says it received 456 complaints that were directly related to Covid-19 or to the lockdown. Most of these complaints were about claims for retrenchment or inability to earn an income.

One issue that arose was whether an insurer is obliged to pay a claim for benefits related to an inability to earn an income when a policyholder receives Temporary Employee/Employer Relief Scheme (Ters) payments. The office has now determined that Ters cannot be regarded as income earned and, therefore, cannot be the reason for a claim to be declined.

The ombud, Judge Ron McLaren, said he was concerned that some insurers were still not applying the Treating Customers Fairly policy correctly in dealing with policyholders, “which is unfortunate, particularly when the policyholder is already in distress”.