Annual Report 2020

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Statistical Summary of Long-Term Insurance Cases Finalised

Table of statistical summary of full cases finalised

  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

There were no material changes in the numbers or percentages of finalised cases in the different categories. Declined claims are still the biggest cause of complaints, with a slightly higher percentage of the total complaints than in 2019. The other categories are remarkably consistent with those of previous years.

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.