Annual Report 2020

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Long-Term Insurance Statistics

Requests for assistance received​

We received 14 198 requests for assistance in 2020, which was an increase of 2 283 or 19% over the 11 915 received in 2019. Our jurisdictional assessment team had to work hard to keep up with this inflow.

6 756 were chargeable complaints which we accepted for further consideration – this was an increase of 10% over the 6 107 of 2019.

Transfers increased to 4 782 from the 4 051 in 2019. Insurers managed to settle 1 373 of these directly with complainants. This amounted to 28.7% which is consistent with 28.06% in 2019 and 28.6% in 2018.

Reviews increased to 1 342 from
1 293 in 2019.

Description of chargeable complaints

Consist of simple complaints that are within the jurisdiction of the office, but which insurers can handle without the office’s involvement. The complainant is always advised that if the matter is not resolved he/she can revert to us. There are also some complaints which have no prospect of success. The assessing staff dismiss these complaints and explain the reasons for the dismissal to the complainants. In these complaints the insurers are charged the reduced mini case fee.

These are complaints not previously seen by insurers and referred to them to try and resolve directly with the complainant. If not resolved and if the complainant, when contacted by the office, requests us to do so, they are taken up by the office as Reviews and handled in the same manner as Full Cases.

These are complaints that have already been seen by insurers and they are handled by the office from inception to finalisation.

Monthly chargeable complaints received 2020

Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec

Chargeable complaints received

2020

6 756

Full Cases
1 847
Transfers
4 782
Mini Cases
127

2019

6 107

Full Cases
1 889
Transfers
4 051
Mini Cases
157

COVID-19 complaints: types of benefits

There were 456 complaints that were directly related to COVID-19 or the lockdown. The majority of these (36%) were in respect of credit life benefits, which is a very different picture from our overall complaints where credit life benefits make up on 9% of cases. Claims for retrenchment and inability to earn an income caused the highest number of complaints, which is perhaps not surprising as the economy suffered, and these are also the more contentious claims.

Credit Life: 164
Funeral: 111
Health: 31
Disability: 12
Life: 134
Other: 4

Cases finalised incorporate Full Cases as well as Reviews. These are the cases that the office considered and resolved during the year. In 2020 this amounted to 3 624, which is 66 more than the 3 558 in 2019. In total, including Transfers closed, 6 512 complaints were finalised in 2020.

The office is funded by way of a levy, which amounts to 10% of our funding, and the rest is by way of case fees which are charged for cases handled by the office, irrespective of the outcome thereof. The benchmark Standard Case fee was R4 387.

As a result of an error detected when invoicing insurers for 2020/2021, the case fee for 2018 and 2019 had to be adjusted retrospectively. The 2018 adjusted standard case fee is R3 868 and the 2019 fee, R4 390. This error did not affect the financial accounts for the two years.

Finalised cases are categorised as follows for charging purposes:

This term refers to the benchmark category of cases.

These are cases in which the insurer gave a late or an inadequate response. These cases are charged at either double or triple the Standard Case fee, depending on the extent of the incompetence.

These cases are difficult to deal with because of complex legal, medical or financial issues or as a result of the complainant’s persistence.

These are cases involving complaints about funeral policies issued by small insurers in which the complaint is resolved on the first response from the insurer. A reduced fee is charged for these cases.

Types of benefits

The benefit types were very similar to previous years, with only funeral benefits reducing slightly by 3% but still remaining as the highest category of finalised cases.

9%
8%
9%
39%
42%
41%
34%
32%
30%
8%
8%
8%
10%
10%
12%

Cases Finalised

2020

3 624

Standard
2 921
Basic
29
Complicated
468
Incompetent
142
Complicated+
64

2019

3 558

Standard
2 842
Basic
21
Complicated
492
Incompetent
157
Complicated+
46

Finalisation period

It is gratifying that the percentage of complaints finalised within six months was 90%. This was despite the effect of the COVID-19 pandemic and lockdowns and the fact that some insurers were tardy in their responses as can be seen from the number of second reminders on page 34 of this Annual Report.