Annual Report 2020

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Complaints Data for Long-Term Insurance Subscribing Members

The office will publish individual insurer complaints data for the period 1 January 2020 to 31 December 2020 on its website, www.ombud.co.za.

The publication is done in order to promote accountability and transparency. It will also encourage insurers to benchmark their standards of complaints handling against other insurers and to learn from insurers who appear to be better at complaints handling.

The information to be published on the website under the heading “Complaints Data” and herein, shows the number of complaints received; the number of cases considered; the number of cases finalised and the number of cases resolved in favour of the complainant, i.e. the W/P (Wholly or Partially) percentage. In addition, Table 2 on the website reflects the nature of the complaints.

The office does not interpret what any of the figures may mean. That is left to insurers, intermediaries and industry bodies, reporters and consumer organisations, as we are of the view that such interpretation and comment by us would not be consistent with our role in impartial dispute resolution.

Although there are a number of published reports reflecting market share in the long-term insurance industry, there is no single generally accepted measure for it and, therefore, this is not reflected in the published data. Another reason for not including market share is that the office does not hold the underlying data that could be used to determine market share and this makes it impossible for the office to verify its correctness. The only context is the individual insurer’s complaints expressed as a percentage of the total complaints received.

Second reminders for responses

Where an insurer has more than five second reminders per year, the number of reminders is published with the complaints data.

Mouse-over the chart to see the names of the insurers and the number of the second reminders sent to them during 2020 appear alongside.

More than five second reminders 2020

Wholly or Partially (W/P) in favour of complainants

A W/P classification applies whenever a case is resolved either wholly or partially in favour of a complainant, whether by settlement or determination. This includes so-called ex gratia settlements. The W/P classification is not limited to cases where the office issued a determination. The classification is also not limited to cases where a sum of money is paid to a complainant – it can apply to service complaints, reinstatement of policies, adjustment of benefits, etc.


We wish to caution against an over-emphasis of the W/P percentage, which should not be viewed in isolation. A low W/P percentage in favour of complainants is, by itself, not necessarily good or an indication that the insurer has exemplary complaints handling processes. Neither is a higher percentage necessarily negative or an indication that the insurer’s complaints handling is poor.


Some insurers are more inclined than others to settle matters. Such insurers choose to settle matters, either wholly or partially, when there may, strictly speaking, be doubt about legal liability.


There may also have been a bulk case situation, i.e. a large number of cases on the same issue. This can “skew” the W/P percentage either up or down for one or more years. This effect is noticeable when an insurer’s W/P percentage changes markedly from previous years.


Of course, if an insurer has a disproportionately high percentage of complaints and has had a high W/P percentage for a number of years, that would raise a question about its complaints management and other practices.


The complaints data should be used by intermediaries, consumers and others in conjunction with other measures, such as an insurer’s claims ratio, its efficiency generally, its products, etc. to give a full picture of an insurer’s performance.

The table below shows:

  • Complaints received
    This is the number of new complaints received in respect of an individual insurer. Some of these complaints will be sent to the insurer to deal with the complainants directly. If a complainant is not satisfied with the insurer’s response we will then take up the case.

  • Percentage of total
    This indicates the complaints received in respect of an individual insurer expressed as a percentage (to two decimal places) of the total number of complaints received by our office.

    These are the complaints where case files are opened and complaints are investigated by our office.

  • Cases finalised
    These are the cases finalised during 2020, some of which had been received in earlier years. Percentage resolved W/P in favour of complainants

    This refers to the percentage of cases which were resolved wholly or partially (W/P) in favour of the complainants. These cases are resolved by way of settlement, mediation, conciliation, recommendation or determination. The overall W/P percentage in favour of complainants was 31.73%.

  • Cases considered
    These are the complaints where case files are opened and complaints are investigated by our office.

  • Cases finalised
    These are the cases finalised during 2020, some of which had been received in earlier years.

  • Percentage resolved W/P in favour of complainants
    This refers to the percentage of cases which were resolved wholly or partially (W/P) in favour of the complainants. These cases are resolved by way of settlement, mediation, conciliation, recommendation or determination. The overall W/P percentage in favour of complainants was 31.73%.

Name of InsurerComplaint Received% of TotalCases ConsideredCases FinalisedResolved W/P in favour of Complainants