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Consumer Affairs
Sunday, January 1, 1989
Few complaints

Considering that there are some 5m life policies in force within the Republic, the 200 complaints that were sent to the ombudsman last year may seem insignificant.
Also during the year 91 cases were finalised. If everyone knows about the ombudsman and everyone feels confident any complaint they may have would be worth pursuing at such level, then the life assurance industry looks a model of good ethical conduct.
However, for one thing few people are aware that such a body exists; for another the SA Co-ordinating Consumer Council in Pretoria is receiving more than those number of complaints every month; many of them relating to short-term insurance, but a few concerning the life assurers. Sometimes it is the Consumer Council which refers complaints to the ombudsman.
The ombudsman was established in 1985 by 32 assurance companies. Derived from a Swedish word meaning an official who investigates citizens’ complaints against the government and its servants, the ombudsman currently in office is former Appeal Court Judge, Gerhardus P.C. Kotzé. His role entails acting as a cordial medium between disputing policyholders and their assurers. He works totally independently of the Life Offices’ Association.
Before the advent of this service, the furthest a policyholder could take his or her complaint prior to court was general management level. The complainant had to embark on a fairly laborious process that would rarely take him much further than branch level and only, with great persistence, up to top management; even then matters were often halted by a plethora of red tape.
Nowadays the disgruntled policyholder has a further course of action open to him. Judge Kotzé will assess the situation and suggest a possible solution to either the complainant or the assurer. These suggestions are, however, by no means binding. If the policyholder is still not satisfied with the result he or she may ultimately take the matter to court. On the other hand, if the assurance company disagrees with the ombudsman’s view, it may also decline his advice.
So far this course of action by the assurer has been rare. Most assurance companies wish to appear as ethical as possible to the public eye by co-operating with the service provided by the ombudsman.
Of course, he is not guaranteed to be in favour of the policyholder. Only after careful assessment of the complaint will a decision be made, regardless of how right or wrong the policyholder may view the whole affair.
Recently there has been some doubt within the industry regarding the extent to which the ombudsman’s service provides positive action. Many feel that he is only giving a service already provided by the assurance companies themselves or by the Consumer Council in Pretoria.
According to Judge Kotzé what is often overlooked is that the service provided by him is a relatively new one. “Many policyholders are still unaware of the existence of the office. But as time passes they will inevitably become better informed,” he says. “Since the service was established in 1985, complaints referred to me have doubled and this in itself shows the growing awareness of the existence of the office amongst the public.”
Asked how he saw his role within the industry, Judge Kotzé said that he felt the service was a “useful one. Complaints which are referred to me are advanced cases where general life assurance management feels it can take matters no further. Management often suggests that recourse be made to the ombudsman.”
He continued that the service he provided was a “rewarding task” as most companies accept his authority and abide by his final decisions.
He concluded that the creation of the office is “an indication of the desire of the life assurance industry to maintain a good image.”

Copyright © Insurance Times and Investments® Vol:2.1 1st January, 1989
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