Cape Town - As in 2014, claims declined by long-term insurers again made up most of the complaints (55%) received by the Ombudsman for Long-term Insurance in 2015.
The types of long-term insurance products most consumers complained about were funeral cover (35% of complaints) and life cover (31%). Complaints in the health category decreased for the third consecutive year to 14% as a result of fewer complaints about hospital cash plans.
Complaints about poor communication - usually the second largest category of complaints - however, showed an annual decrease this time.
The office of the Ombudsman for Long-term Insurance said on Tuesday that it recovered R184.4m in the form of lump sums for consumers from long-term insurance companies during 2015.
Complainants received more than R577 000 in compensation because of poor service. These amounts do not include income benefits, annuity payments and the value of non-monetary benefits.
At the release of its annual report for 2015, Long-term Insurance Ombudsman Ron McLaren said it had received 9 815 written requests for assistance in 2015, an increase of 6% on the previous year.
Of these, 5 018 were chargeable complaints, with 3 491 cases full cases finalised and 75% of cases finalised within six months of receiving them. Almost 30% of cases were resolved in favour of the complainant, slightly up on 2014’s 29.7%.
“It is promising that insurers seem to have worked hard to communicate more clearly with their clients about policy terms and conditions,” said McLaren. “Good progress has been made on complying with 'treating customers fairly' principles too.”
Unreasonable complaints
McLaren noted that there had been a steady increase in the number of unreasonable complainants and in the number of complex complaints against long-term insurers.
“This appears to be a worldwide phenomenon, with the reasons for unreasonable conduct including anger, frustration and an exaggerated sense of entitlement,” explained McLaren.
“Some complainants claim to be seeking ‘justice’ or ‘a moral outcome’, but tend to display unreasonable arguments, behaviour, demands and persistence as well as unwillingness to co-operate.”
There was also an increase in the number of complaints that were lodged directly with the office of the Ombudsman, rather than through insurers.