File Image: IOL
File Image: IOL

Disputing a rejected insurance claim - What you need to know

By Staff Reporter Time of article published Jun 30, 2021

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Lodging a dispute against an insurer need not be a daunting task. Last year insurers paid out close to R300 million in claims following reviews by the combined Ombud office for the insurance sector, which consists of both the Long-term Insurance and Short-term Insurance Ombudsman.

“What many customers forget is that when it comes to life insurance you are allowed to submit a dispute if you are not satisfied with the way your insurer has handled your claim,” says Elaine Markus, ‎Head of Assurance Products and Assurance Claims at Standard Bank Insurance Brokers.

Long-term insurance covers life-changing events like becoming seriously ill, disabled, or dying. Two of the most common forms of long-term insurance are life insurance and funeral cover. This kind of cover is important because it allows customers to take care of their loved ones, and to remove the financial burden that they are left with after the policy holder is no longer there to take of them or can longer afford to.

“Don’t let big words or terms throw you off. Life insurance is important, and you need to understand your policy and know your rights when it comes to disputing a rejected claim. The process for submitting a complaint is straightforward,” says Markus.

Any customer has the right to dispute the outcome of a claim if they are not satisfied with it. To begin with, there is usually an internal complaints process that the customer will need to follow. The policy terms and conditions will contain the details of the complaints department. The customer can contact the complaints department and submit a complaint.

If the customer is not satisfied with the outcome of the dispute resolution process, they can approach the Ombud for Long-term Insurance who acts as a mediator between policyholders and long-term insurers. They are independent and objective and looks after the interest of both the insurer and the customer. The details of the Ombudsman can also be found on the terms and conditions of the policy.

When purchasing long-term insurance financial services providers must ensure that customers are provided with appropriate and sufficient information to enable them to make an informed decision.

“As a customer, when purchasing long-term insurance really understand where you are at this point in your life, what your needs are, who you want to cover and the size of your outstanding debt. Also, make sure that you understand your contract,” Markus says.


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