Organization : The Ombudsman For Long-Term Insurance
Service Name : Making a Complaint
Town : Claremont
Website : http://www.ombud.co.za/
Submit a Complaint: http://www.ombud.co.za/how-to-complain/submit-a-complaint
Ombudsman How To Complain
Contact your insurer first :
** Your insurer should be given the opportunity to resolve the problem or complaint before it is referred to the Ombudsman.
** Contact us if you are not satisfied with the response.
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Requirements for complaints submitted to the Ombudsman :
** The complaint must be in writing, or with our assistance at telephone.
Please provide us with the following information :
** policy number/s;
** insurance company;
** policyholder contact details;
** factual summary of your complaint; and
** letter of mandate if you are writing on behalf of the policyholder or beneficiary.
** Keep the details of your complaint as short and factual as possible.
** Provide us with copies of supporting documents referred to in the complaint, including correspondence with the insurer.
** Please write neatly. Type if possible. Black ink should be used for faxed correspondence.
** A complaint can be submitted in the language of your choice
What happens next?
** You will receive a letter of acknowledgement advising you about the line of action we intend to take.
** Should the complaint fall within the ambit of our rules, we will write to the insurer concerned requesting an investigation of the matter.
** The insurer is requested to respond within six weeks. On receipt of a written response the complaint will either be decided and the complainant advised accordingly or further information or comment might be requested from either or both parties.
** This is a service free of charge to the public.
** The operating costs of the office are met by subscribing members of the long-term insurance industry.
Fairness Checklist :
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.
** Always complete a proposal form for a policy yourself. Only in this way will you fully understand the nature of the information required.
** Information sought is never a formality and complete and accurate information is always required.
** If in doubt, disclose information.
** Always read any document before you sign it.
** Read through the policy contract to ensure that the documents conform to your expectations or what you understood the contract to be.
** Keep written proof of your correspondence and dealings with the insurer and your intermediary.
Private Bag X45,
Telephone No.: (021) 657 5000
Fax No.: (021) 674 0951
E-mail: info AT ombud.co.za