Statistical Summary of Long-Term Insurance Cases Finalised
Table of statistical summary of full cases finalised
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| Life | Disability | Health | Funeral | TOTALS | % OF TOTAL | |||||||||||||||||
| Nature of Complaint | 2019 | W/P* | 2020 | W/P* | 2019 | W/P* | 2020 | W/P* | 2019 | W/P* | 2020 | W/P* | 2019 | W/P* | 2020 | W/P* | 2019 | W/P* | 2020 | W/P* | 2019 | 2020 |
| Poor communications/ documents or information not supplied/poor service |
504 | 37% | 527 | 31% | 37 | 35% | 46 | 35% | 51 | 27% | 31 | 32% | 509 | 54% | 460 | 49% | 1,101 | 44% | 1,064 | 39% | 30.94% | 29.36% |
| Claims declined (policy terms or conditions not recognised or met) |
437 | 27% | 502 | 28% | 273 | 37% | 333 | 35% | 198 | 21% | 226 | 29% | 767 | 36% | 753 | 31% | 1,675 | 32% | 1,814 | 30% | 47.08% | 50.05% |
| Claims declined (non-disclosure) |
101 | 24% | 88 | 22% | 54 | 19% | 39 | 28% | 27 | 19% | 29 | 14% | 12 | 33% | 5 | 40% | 194 | 22% | 161 | 22% | 5.45% | 4.44% |
| Dissatisfaction with policy performance and maturity values | 122 | 11% | 112 | 13% | 0 | 0% | 1 | 0% | 0 | 0% | 0 | 0% | 1 | 0% | 1 | 0% | 123 | 11% | 114 | 12% | 3.46% | 3.15% |
| Dissatisfaction with surrender or paid-up values | 59 | 10% | 55 | 13% | 0 | 0% | 0 | 0% | 1 | 100% | 0 | 0% | 2 | 0% | 0 | 0% | 62 | 11% | 55 | 13% | 1.74% | 1.52% |
| Misselling | 17 | 24% | 10 | 10% | 1 | 0% | 1 | 100% | 0 | 0% | 0 | 0% | 1 | 100% | 6 | 67% | 19 | 26% | 17 | 35% | 0.53% | 0.47% |
| Lapsing | 79 | 33% | 78 | 23% | 1 | 0% | 1 | 0% | 2 | 50% | 4 | 25% | 139 | 38% | 163 | 35% | 221 | 36% | 246 | 31% | 6.21% | 6.79% |
| Miscellaneous | 100 | 35% | 104 | 25% | 7 | 14% | 7 | 57% | 5 | 40% | 6 | 67% | 51 | 27% | 36 | 39% | 163 | 25% | 153 | 30% | 4.59% | 4.22% |
| Total | 1,419 | 28.3% | 1,476 | 26.3% | 373 | 33.2% | 428 | 34.3% | 284 | 22.5% | 296 | 28.4% | 1,482 | 42% | 1,424 | 37% | 3,558 | 34.0% | 3,624 | 31.73% | 100% | 100% |
* Resolved wholly or partially in favour of the complainant.
Nature of complaint
The Treating Customers Fairly outcome categories as contained in the Policyholder Protection Rules (“PPR”), appear in the block alongside. There has also been very little change from 2019 in this categorisation.
PPR complaints categorisation
| Design of policy or related service | 0.06% |
| Information provided to policyholders | 11.3% |
| Advice | 0.4% |
| Policy performance | 4.1% |
| Service to policyholders | 12.9% |
| Policy accessibility, changes and switches | 2.8% |
| Complaints handling | 0.6% |
| Insurance risk claims | 60.4% |
| Other complaints | 1.5% |
| Total | 100% |
Resolved wholly or partially (“W/P”) in favour of complainants
The percentage of cases resolved in favour of complainants decreased from 34.12% in 2019 to 31.73% in 2020. If we add the Transfers settled in favour of complainants, then the W/P percentage increases to 39%.
R177.9 million was recovered for complainants in the form of lump sums. This figure does not reflect the value of all benefits awarded in favour of complainants, such as recurring income or instalment benefits, annuities, the reinstatement of policies, etc.
The amount of compensation awarded to complainants in terms of Rule 3.2.5 amounted to R817 970 in 208 cases as compared to the R874 286 in 190 cases in 2019.
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