Annual Report 2020

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Long-Term Insurance Independent External Assessor

During 2014 Judge R Cleaver was appointed in the above position to receive and to consider service complaints against the office by complainants and insurers. A service complaint is about the practical handling of a complaint by the office and it does not relate to the outcome of a complaint. A special procedure is provided for dealing with such service-related complaints.

Further information can be obtained on our website: www.ombud.co.za.

During 2020 Judge Cleaver dismissed all four complaints to him about the office and, in the concluding paragraphs of his rulings, he said the following:

  • “In my view the complaint was dealt with in a perfectly reasonable and competent manner. The assessor dealing with the complaint merely sought information from the complainant as to whether she had any record of payments made during a stated period. It was the abusive and unreasonable tone of her reply that put an end to any further consideration of the complaint. In the circumstances the complaint to me cannot be sustained.”

  • “In my view the complaints were dealt with in a reasonable manner and in the result cannot be sustained.”

  • “In the circumstances it is not necessary to go through the complainant’s grounds of appeal or re-assess her case, for all I am permitted to do is to establish, by reference to all the correspondence whether the office provided the complainant with a reasonable service in dealing with her complaint against the insurer. I am quite satisfied that the complainant was offered a reasonable service. Her complaint was fully and adequately put to the insurer and the latter’s response was properly conveyed to her before the rulings were made by the Ombudsman. Accordingly her complaint to me cannot be sustained.”

  • “I am quite satisfied that the complainant was offered a reasonable service. His complaint was fully and adequately put to the insurer and the latter’s response was properly conveyed to him before the rulings were made by the Ombudsman. In fact, the Office went so far as to facilitate the offer of settlement from the insurer which was accepted by the complainant. Accordingly his complaint to me cannot be sustained.”