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Funeral claims bulk of ombud complaints

Apr 17 2012 16:10 Sapa

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Johannesburg - Funeral policy complaints made up 37% of the total number of gripes finalised by the ombudsman for long-term insurance in 2011, according to the annual report released on Tuesday.

In 2010, 33% of complaints related to funeral policies.

The office received a similar number of complaints last year (9 195) as in 2010 (9 215).

A total of 40% of all cases were resolved wholly or partially in favour of complainants, down from 46% in 2010, according to the report.

During 2011, 58% of finalised cases were marked as claims declined. This category has been the largest category for the last eight years, as well as the largest growth area.

Insurers are now required to advise consumers that they have the right to lodge complaints with the office when their claims are denied, according to the report.

The ombudsman noted that consumers are frequently unaware of what their insurance policy covers, particularly in respect of health policies.

Insurance products could be promoted in a misleading way. An advert could inform consumers they are not required to undergo a medical exam when applying for cover, creating the impression that this is an advantage of the product.

But where insurers do not require medical exams as a prerequisite for cover, they would usually exclude pre-existing medical conditions.

Health policies could also contain unclear wording. While they contain medical terms out of necessity, even if these are accurate and clear to doctors, they might not necessarily be for lay consumers.

"A policyholder might therefore be covered for a heart attack or cancer, but might find out at claim stage that because of the definition of the conditions his particular heart attack or cancer is not necessarily covered," the ombudsman's office said.

But policies where the medical wording is itself unclear or insufficient present a greater problem.
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