CR191 Misleading marketing practices


Misleading marketing practices – “Education Plan” – refund of premiums – four variations on a common theme.

This office has recently had to deal with four separate complaints about Company X’s “Education Plan”.

In all four cases the structure of the product was broadly the same. The plan (termed the X Education Plan) was marketed by Company X during the late 1990’s.

In each case it was presented to prospective policyholders as an education plan that would provide for the secondary and tertiary education of their children.

The product consisted of:

(a) a life policy component with both life and disability cover and a subsidiary cash benefit payable into an education trust fund on the death or disability of the parent (the policyholder). A specific premium was stipulated;

(b) a unit trust savings component “to meet the cost of education in the medium to long-term” with a separate contribution.

The rationale was that the unit trust component would grow as contributions were received and invested. This would supply the savings element to fund the future education.

The application form for the plan had one section relating to the life policy component and a separate section relating to the unit trust component.

The problem in some of the complaints lodged with our office was that neither the marketing material nor the representations by Company X’s agents made it sufficiently clear to prospective policyholders that it was essential for a policyholder to complete both sections for the plan to function at its optimum. As it was put by one of Company X’s senior representatives in correspondence: “Our intention in selling the plan was as a comprehensive education plan. Initially the Education Trust was set up as a single needs sales organisation to sell a holistic product to people faced with the rapidly rising costs of education. The plan had a two-fold objective; to give cover for the child in the event of the parent’s early death, combined with a trust set up by Company X to look after the proceeds for the benefit of the orphan’s education, and also a savings element in the form of a unit trust. Either portion of the plan can stand on its own merits but ultimately the plan was best in combination”.

In two of the cases the policyholder’s grievance was that he/she laboured under a misapprehension as to the true nature of the product and the reciprocal obligations of the insurer; and that the plan was misunderstood because of the ambiguous nature of the marketing material and the manner in which the product was explained to them. It appears that the policyholders had in mind, when they purchased the product, that it was a standard policy that would pay out when their children reached tertiary education age. It was never properly made clear that the unit trust investment, although an optional extra, was essential for the plan to fulfil its stated purpose; and that if the unit trust section was not completed and implemented the plan would be little more than an ordinary life policy with only a minor savings element.

As the plan was structured by Company X the main component was the life cover and not the unit trust savings element. Yet Company X’s representative conceded: “It should be borne in mind that the initial life cover was not great, giving this plan an element of savings. However, without the savings element inherent in the unit trust, the plan would not fulfil its potential”. If the emphasis was, as it should have been, on the savings element, the unit trust selection should have been the anchor provision and not the life policy which was only intended to cater for the eventuality that the policyholder should predecease the child. The life policy should at best have been an adjunct to the savings portion and not, as was the case, the fulcrum of the plan.

First case

In the first case the complainant complained that what she got, a life policy, is not what she wanted, “a savings plan for my two sons’ education”. That is because she did not complete the unit trust section of the application form which remained blank. The premiums paid also related only to the life policy section.

The complainant, when she discovered after nine years that she had basically signed up for a universal whole life policy with disability benefits, wanted her premiums back.

We pointed out to the insurer that the absence of the unit trust investment defeated the purpose of the plan. When Company X retorted that “the unit trust part was optional”, we pointed out that this was not in accordance with the “Advisers’ Guide” it issued, which emphasised that the basic plan “combines” a universal whole life policy with investments in unit trusts.

The insurer thereupon responded that “after careful consideration of the fact that [the complainant’s] intention was a savings plan for the education of her children and the non-activation of the unit trust savings plan” they had decided to comply with the request “to refund premiums and interest thereon from the date of commencement of the risk cover”. And so it was done.

Second case

The facts of the in this case were broadly on a par with those of the first case but with one notable variation. As in the first case the unit trust section remained blank and only the life policy section was completed for which a premium was paid. The distinguishing feature was that the policyholder, on discovering that the product was not what she thought it was and was in effect merely a life policy with a minor savings element, surrendered the policy and pocketed the proceeds.

At an adjudicators’ meeting we considered and debated the potential causes of action open to the complainant. These were:

(a) Pre-contractual misrepresentation

The misrepresentation would conceivably be the ambiguous marketing material and the misleading manner in which the product was explained to her by Company X’s agent. But the fact remains that the product as such could function as an education plan proper if both sections had been duly completed. The “misrepresentation” was therefore not so much as to the nature of the product but as to the completion thereof by the complainant herself. Moreover, the misrepresentation, having been made in 1997, could hardly be raised as a ground for rescission in 2006, particularly not when the complainant chose to surrender the policy in terms of the policy provisions, which served as an affirmation of the policy rather than as an election to rescind it.

(b) Pre-contractual breach of mandate

This could conceivably be on the footing that the complainant instructed Company X’s agent to provide her with an education plan whereas the agent in effect signed her up for a life policy. Here again the difficulty is that the product as such was indeed an education plan but only effectively so if both sections had been completed. The difficulty arose not with the plan as such but because of the advice (or absence of advice) she received in completing it. The problem was therefore not so much the mandate that was breached but:

(i) that she did not fully appreciate that if she did not complete the unit trust section the plan would only provide for the eventuality of her predeceasing her child; and

(ii) that she was not properly forewarned or informed what the situation would be if she failed to complete the unit trust section as well.

(c) Absence of consensus

There can be little doubt that on the probabilities the complainant did not fully understand the nature of the product and in particular that it was only a life policy and not a savings plan. Was she entitled to rely on her mistake? As a rule she would only be able to do so if her mistake was reasonable. In the particular circumstances of this case, however, there was a duty on Company X, in its marketing material and through its agent, to explain to the complainant that the manner in which she completed the form would not secure her child’s education and that it was restricted to the situation where she would predecease her child, an eventuality which was in any event covered by her own existing life policies. To the extent that her misapprehension as to the nature of the policy was therefore attributable to the other contracting party, Company X through its agent, it remained open to her to rely on her absence of consensus. The consequence would be that there was no contract and she would be entitled, subject to what is said below in relation to her surrender of the policy, to a refund of her premiums.

(d) The effect of the surrender

Was the fact that she had earlier surrendered her policy an insurmountable obstacle in raising the invalidity of the policy on the grounds of an absence of consensus? That was a consideration that troubled the meeting since the fact of surrender postulated the existence of a valid contract. If the contract itself was invalid because of an absence of consensus, so too would be the act of surrender, since one cannot surrender an invalid contract. That is particularly true if the policyholder’s decision to surrender was due to the very reason rendering the contract void from inception, namely that the complainant was never informed that the policy was merely a life policy and not a true education policy. The decision to surrender was an ill-conceived decision but coloured by exactly the same cause which affected the validity of the policy in the first place, namely the lack of a proper understanding of its terms. As such the meeting concluded that it should not be regarded as an insurmountable obstacle for the corollary would otherwise be that the ill-conceived surrender of the policy would breathe life into an otherwise invalid policy.

On the premise that the policy was invalid and that the surrender did not preclude the complainant from raising the invalidity, we informed the insurer that the complainant was in principle entitled to a refund of the premiums paid but that the amount already received by way of surrender should be deducted from that sum.

Moreover, since the insurer had the use of the excess it should pay interest, not at the legal rate but, so we suggested in fairness to both parties, at the lower Standard Bank rate for 12 months deposits as recommended in the Life Offices Association protocol in respect of death or disability claims.

This latter aspect opened up a new area of debate. The insurer made the point that if the insured had died, Company X would not have been able to resist a claim on the policy on the grounds that the insured laboured under a misapprehension as to what she had purchased. That line of defence was open to the insured because of the conduct of the insurer; it was not open to the insurer itself. Notionally, if not actually, Company X was accordingly at risk. The insurer suggested that the costs of life and disability cover should be deducted from the refund, but the meeting felt that the most equitable solution would be to account for that factor in a reduced rate of interest.

A provisional ruling was made to repay the difference between the premiums paid by the complainant and the surrender value she received, which amounted to some R4500,00, plus interest at 7.25% per annum from the date of payment of the surrender amount to date of payment of the balance. This was less than the recommendd rate in the LOA protocol. Neither party raised any further submissions and the matter was disposed of on that basis.

Third case

8. The third case followed a different course from the previous two cases inasmuch as the unit trust section was fully completed and a managed fund was selected as the investment option by the two complainants, the parents of the children to be benefited. They undertook to pay an additional contribution by way of a debit order in respect of the unit trust portion. That, however, never happened because, as Company X discovered later, “the debit order for the unit trust portion on the policy in force had never been lodged…..Unfortunately it would appear that the unit trust department never contacted the client concerning this and as a result the debit order was never activated.” The premiums paid were only in respect of the life insurance portion.

As in the previous two cases the policy was conceived as an education plan. Both the life and the investment portions thereof were integral to the effective functioning of the education plan as Company X conceded. The plan spelt this out and expressly referred to the monthly premiums and contributions in respect of each portion thereof. Both sections of the application form had been duly completed.

Company X also conceded that the fault was theirs for not activating the debit order and offered a sum of R3000,00 “by way of a conciliatory goodwill offer”.

The complainants were not interested in reinstating the unit trust portion of the policy and accepted the offer. The file was closed.

Fourth case

The last case resembles the third one in the sense that the complainant completed both the life cover section at a premium of R100 per month and the unit trust section of the application form, inserting R50,00 as the contribution, and selecting both an escalation rate and a designated fund.

The problem was that the insurer in the follow-up documentation reflected only the premium for the life cover component and made no mention of the unit trust option selected by the complainant. Again no contributions were collected by debit order in respect of the unit trust portion.

The complainant, on discovering this state of affairs some time thereafter, stated that she was not interested in life cover and wanted the entire transaction set aside and her premiums returned to her.

We were unable to agree.

We pointed out to her that she was bound by the application form which she understood, completed and signed and which was accepted by Company X; that the documentation clearly spelt out from the outset that there was a life policy component which she selected and that, as a result, it was not possible for her to contend that as a reasonable person she was unaware of that fact. Accordingly she was not entitled to have the entire transaction set aside. This was not, after all, a case of lack of consensus about the terms of the policy; it was a case of lack of proper implementation of the agreed and understood terms of the policy.

Company X was prepared, at our insistence, to accommodate the complainant by reconstituting the plan to what it would have been if the unit trust account had been activated as it should have been at the time; or, if the complainant was not prepared to pay in the arrear contributions, that the sum assured could be adjusted and downscaled to allow for the payment of the arrear contributions on the unit trust account. The insurer was also prepared to pay R2500,00 as compensation for poor service.

The complainant thereupon asked us to explore the best way of reconstituting the contract.

The insurer submitted various calculations on the premise that the complainant would have to pay in a certain lump sum for arrear contributions. Matters reached a fairly advanced stage when the complainant suddenly decided, without any explanation to us, to surrender the life policy – and everything came to an abrupt end. Much effort, little reward.

November 2006

CR190 Misleading marketing material – ‘n aantal onlangse gevalle uit die lêers van die Ombudsman vir Langtermynversekering.


Misleading marketing material – ‘n aantal onlangse gevalle uit die lêers van die Ombudsman vir Langtermynversekering.

Bemarkingsmateriaal moet mens maar altyd met ‘n knippie sout neem. Maar daar kom ‘n punt waar bemarkingsmateriaal aan ‘n belofte of selfs ‘n leuen grens en wanneer dit gebeur en ‘n verbruiker as gevolg daarvan ‘n onvanpaste polis koop, word dit soms nodig vir die Ombudsman vir Langtermynversekering om in te gryp.

Die kantoor van die Ombudsman is juis daar om sulke gevalle kosteloos op aandrang van verontregte verbruikers te ondersoek en, as daar meriete in die klagte is, die verbruiker behulpsaam te wees.

Ons noem ‘n paar gevalle van suksesvolle klagtes. (Vanweë die Ombudsman se beleid van vetroulikheid word name nie genoem nie.)

Eerste voorbeeld

Enkele jare gelede het ‘n bepaalde versekeraar ‘n “spesiale aanbod” in die pos aan al sy bestaande polishouers van onder ‘n bepaalde ouderdom gestuur. Die brosjure het gemeld: “Belê vandag R50 en in net 16 jaar se tyd is u R50 000 belastingvry ryker!” en weer: “Besluit vandag wat jy maandeliks kan bekostig om te belê. Wat dit ook al mag wees, voeg 000 by en oor 16 jaar ontvang u ‘n aansienlike som – alles belastingvry!”.

In die aansoekvorm self was daar egter ‘n sinnetjie versteek wat gelui het: “Beraamde kontantbetalings is op heersende winsprestasies gegrond”.

Die beraamde winsprestasies is egter nooit oor die 16 jaar-tydperk behaal nie en die drie nulle was les bes op die uitkeringsdatum net drie nulle op die kontrak.

In ’n sterk bewoorde klagte na ons kantoor het die klaer, wat R40 per maand belê en R40 000 verwag het, gekla dat hy net ‘n uitkeerbedrag van so ongeveer R31 000 ontvang het.

In sy geval (en in ander dergelike klagtes) kon ons kantoor die versekeraar na onderhandelinge oorreed om, sonder erkenning van aanspreeklikheid, aan die klaer ‘n aanvullende uitkeerbedrag te betaal, weliswaar minder as die verwagte bedrag, maar genoeg om dit darem vir die klaer aanvaarbaar te maak.

Tweede voorbeeld

In ‘n ander geval het ‘n versekeraar ‘n besondere Spaarplan tot ‘n maksimum van R500 000 bemark. Die klaagster is deur ‘n bemarker van die versekeraar omgepraat om op die plan in te teken. Haar gekose premie was R100 per maand. Die polisdokument self, beskryf as ‘n Klassieke Uitkeerplan met inflasie voordele, het vermeld dat dit ‘n bestuurde portfolio was met beleggings in genoteerde gewone aandele.

Die probleem het sy oorsprong in ‘n advertensie-pamflet gehad, getiteld: “The Most-Asked Questions about your Saver Plan” wat die versekeraar versprei het, ondermeer aan die klaagster. Onder die hofie “Can I cash in my plan before it matures?” is gesê: “You must remember that the Saver Plan is designed to enhance your long-term saving. However, in the event of an unforeseen circumstance you can cash in the “accumulated value” at any time after one year.”

Die klaagster het met naaldwerk ‘n inkomste verdien. Toe haar omskep -masjien breek, meer as ‘n jaar nadat sy by die plan aangesluit het, wou sy die geld wat sy inbetaal het (R1200.00) terug hê “aangesien ek in nood was”.

Die maatskappy het om mee te begin glad nie gereageer nie maar was uiteindelik bereid om ‘n afkoopwaarde van R720.00 aan haar te betaal.

Die klaagster was gebelg. Volgens haar is sy, toe die plan aanvanklik aan haar verkoop is, meegedeel dat sy na een jaar alles sou terugkry wat sy betaal het, en dit is ook soos sy die pamflet verstaan het.

Sy het eers by die advertensie-owerhede gaan kla wat bevind het dat die pamflet “appears to exaggerate the amount that the policyholder can actually cash in on the plan after one year”.

Gewapen met dié bevinding het die klaagster by ons kantoor aangeklop. Ons bevinding was ook dat die bemarkingsmateriaal, gepaard met wat tydens die bemarking aan haar gesê is, ‘n polishouer kon laat glo dat sy ‘n bedrag van nie minder nie as die som van die premies wat sy inbetaal het na ‘n jaar, sou kon verhaal. Na ons mening was die klaagster nie alleen op terugbetaling van haar premies geregtig nie maar ook, ooreenkomstig ons Reëls, op R1500 as ‘n solatium vir onbevredigende diens.

Die versekeraar het dit so aanvaar en die bedrae is aldus aan die klaagster betaal.

Derde voorbeeld

Die klaagster, ‘n 47 jarige onderwyseres, was besig om by ‘n bank tou te staan toe ‘n persoon ‘n pamflet aan haar oorhandig het. Die persoon het later geblyk ‘n werknemer te wees van ‘n makelary wat aan die bank verbonde was en wat ‘n lid is van ons skema. Die pamflet het gelui: “Worried? Our expert advice will give you peace of mind. Did you know? – your child’s education, house (new or extensions), a car, security for future needs from day one, may no longer be a worrying factor if you let us show you how.” Die pamflet het origens ‘n noukeurige verduideliking bevat van die kontant bedrae wat op verskillende tye (5, 7, 10, 12 en 15 jaar) uitbetaalbaar sou wees. Op grond daarvan het die klaagster gereken dat sy teen ‘n premie van R500,00 per maand na vyf jaar R51 507.00 sou ontvang. Sy het tot die belegging ingestem.

Die belegging was ongelukkig in buitelandse aandele wat oor die tydperk swak gevaar het. Nadat sy altesaam R40450 inbetaal het, is daar uiteindelik slegs R28 000 aan haar uitbetaal.

Daarop het sy ‘n klagte by ons kantoor aanhangig gemaak.

Die klaagster was Venda-sprekend. Die aansoekvorm wat sy gevra was om te teken was in Afrikaans wat sy nie verstaan het nie. In kleinskrif was daar ‘n bepaling “Opbrengs gekwoteer teen illustratiewe waardes van 12%”. Die bemarker het hierdie begrippe nooit aan haar verduidelik nie. Die klem was deurgaans op die voordele wat die belegging bied maar nooit is sy attent gemaak op die risikos waaraan dit verbonde was nie.

Ons kantoor se mening was dat die bemarkingsmateriaal wel misleidend was; dat die strekking van die belegging nooit behoorlik aan haar verduidelik was nie; en dat die advies wat sy van die bemarker ontvang het om in dié betrokke produk te belê onvanpas was veral waar die risikos nooit aan haar verduidelik was nie.

Ons siening was dat die makelary die verskil aan haar moes betaal tussen die bedrag wat sy wel ontvang het en die bedrag wat sy sou ontvang het as sy behoorlik geadviseer en nie mislei was nie, naamlik die opbrengs van haar betalings in die geldmark oor die tersaaklike tydperk.

Na verdere onderhandelinge is die saak uiteindelik geskik op die grondslag dat die bemarker die helfte van die verskil aan haar sou betaal het asook die regskoste wat sy aangegaan het om die saak by ons kantoor aanhangig te maak.

Volledigheidshalwe kan ons net noem dat dit nie vir haar nodig was om ‘n prokureur se hulp in te roep nie. Al wat ‘n klaer moet doen, is om die basiese feite aan ons te verstrek. As daar onduidelikhede is, sal ons daarna vra.

‘n Paar voorbeelde van onsuksesvolle klagtes.

Maar verbruikers moet darem ook nie naïef wees nie. Daar is ook heelwat gevalle waar ons kantoor die klaer of klaagster nie behulpsaam kon wees nie. Ons noem weer ‘n paar voorbeelde:

Eerste voorbeeld

Die klaer was ‘n finansiële adviseur en ‘n werknemer van versekeraar X teen wie hy sy klagte aanhangig gemaak het. Hy het twee vyf-jaar termyn uitkeerpolisse vir sy kinders by die versekeraar uitgeneem. Sy maandelikse premie op elke polis het R200 beloop. Hy het altesaam ‘n bedrag van R12 000 op elke polis inbetaal maar die polisse het elk net R7 901.00 op uitkeerdatum uitbetaal. Hy was ontevrede omdat die versekeraar, so het hy beweer, maklik beloftes maak en waarborge gee maar dit dan nie gestand doen nie.

Die bemarkingsmateriaal (getiteld “So vaar Versekeraar X se aandele”) bepaal soos volg:

“Die bestuurder van die fonds het volkome beleggingsvryheid. Dit beteken dat hy tot 100% van die fonds se bates in aandele kan belê. Wanneer ander beleggingsmediums, byvoorbeeld kontant of eiendom, egter beter potensiaal toon, sal hy daarin belê (ons beklemtoning).

Die fonds word heeltemal onafhanklik van ‘n ander meer konserwatiewe fonds bestuur. Die fondsbestuurder tree ook meer aggressief op as byvoorbeeld met die aandelekomponent van die ander fonds – wat hierdie fonds die potensiaal gee om uitsonderlike opbrengste te behaal.”

Die gekose fonds het nie waffers presteer nie. Gevolglik, en gedagtig aan die gebruik van die woord “sal”, wou die klaer weet hoekom die versekeraar “dan nie in hierdie ander beleggingsmediums soos kontant of eiendom belê het nie”.

Die versekeraar het ondermeer aangevoer dat:

• die klaer self die adviseur was wat die polisse geskryf het en hy dus ‘n ingeligte besluit geneem het oor die beleggingsfondse waarin die beleggings gedoen is, asook oor die kort termyne van die polisse;

• die mandaat van die fonds bepaal het dat beleggings nie net in aandele hoef te wees nie, maar ook in ander sektore soos kontant of eiendom en ander;

• die portefeulje hoofsaaklik in aandele belê was, maar nooit ten volle nie. Die portefeulje was dus ook in ander sektore belê;

• daar tye was wat die aandele swak gevaar het, maar dat die versekeraar se fondsbestuurders nietemin van mening was dat dit op daardie tydstip die beste besluit was om nie die blootstelling aan aandele te verminder nie;

• die versekeraar geen waarborge aan die klaer verstrek het nie;

• die swak opbrengste nie aan die versekeraar te wyte was nie, maar wel aan die negatiewe verloop van die aandelemark. As adviseur sou die klaer terdeë hiervan bewus gewees het;

• dit nie vir die portefeuljebestuurder moontlik was om te voorspel wat die toekoms vir die markte sou oplewer nie.

Die klagte is op ‘n beregtersvergadering bespreek. Die uitgangspunt van die bemarkingsmateriaal was, volgens die mening van die vergadering, dat die fondsbestuurder ‘n volkome vrye diskresie gegun was om die betrokke fonds na goeddunke te bestuur.

Die woorde “wanneer ander beleggingsmediums, byvoorbeeld kontant of eiendom, egter beter potensiaal toon, sal hy daarin belê”, moes in daardie konteks gelees word: dit bevestig dat hy met markgeleenthede en beleggingspotensiaal tred moes hou en dit in ag moes neem. Aldus kon die belegging in aandele wees of, as die fondsbestuurder van mening was dat kontant of eiendom beter potensiaal bied, kon daarin belê word. “Potensiaal” slaan op die toekoms. Hy moet die potensiaal volgens sy eie subjektiewe siening beoordeel. Sy besluit om wat die huidige betref nie in kontant of eiendom te belê nie maar eerder in aandele, kon dus nie bevraagteken word nie, al sou dit ook, agterna gesien en objektief gesproke, blyk dat sy destydse oordeel dalk verkeerd was.

Bowendien was dit ‘n aspek waaroor die ombudsman se kantoor hom normaalweg nie sou uitspreek nie. Aldus bepaal Reël 3.3.4 dat ‘n klagte nie oorweeg word as dit “voorkom of die klagte hoofsaaklik oor beleggingsprestasies of die legitieme uitoefening deur ‘n deelnemende lid van sy bedryfsoordeel gaan” nie.

Ondanks die gebruik van die woord “sal” in die gewraakte sinsnede, kon die vergadering nie ‘n kontraktuele onderneming of, soos die klaer dit gestel het, ‘n “waarborg” in die bemarkingsmateriaal inlees wat hom op regshulp geregtig sou maak nie.

Die klagte is gevolglik nie gehandhaaf nie.

Tweede voorbeeld

Die klaer se polis by versekeraar X het op 1 Mei 2000 sy uitkeerdatum bereik. Gedurende Januarie 2000 het hy ‘n skrywe van die versekeraar ontvang waarin hy uitgenooi is om die polis in die “Equity International” polis voort te sit. Die volgende aanhalings verskyn in gemelde brief:

“…ons beleggingspan meen dat u ware finansiële voordeel kan geniet deur gebruik te maak van ons Equity International aanbod. Equity International bied die geleentheid om u beleggings uit die onseker plaaslike finansiële markte te verskuif na die vooruitstrewende en gediversifiseerde internasionale markte. Dit sal u belegging in staat stel om internasionaal te floreer en nie gebuk te gaan onder skommelings op die plaaslike mark nie. Byvoorbeeld, indien u net R125 per maand in ‘n Equity International polis belê met ‘n premiegroei van 15% per jaar, sal die uitkeerwaarde na 10 jaar ‘n indrukwekkende R45 891 wees waar ‘n beleggingsopbrengs van 12% per jaar veronderstel is!

U sal besef dat ‘n Equity International polis toegevoegde waarde bied deur inflasie te klop en die groeipotensiaal te bied wat elke polishouer behoort te geniet.”

Nodeloos om te sê (want anders was daar nie ‘n klagte nie), het die belegging swak presteer en het die polishouer by ons kantoor kom kla oor die wanvoorstellings wat na bewering in bogemelde brief deur die versekeraar aan hom gemaak is.

Ons het die klagte op ‘n beregtersvergadering bespreek. Ons het tot die gevolgtrekking gekom dat, ofskoon die brief dalk te optimisties oor verwagte groei en prestasie was, dit nie op iets meer as die uitspreek van ‘n opinie, inaggenome die versekeraar se historiese prestasie, voorgekom het nie. Derhalwe kon gemelde skrywe nie as ‘n feitelike stelling wat as ‘n wanvoorstelling gekonstrueer kon word, gesien word nie. Dit kon ook nie redelikerwys as ‘n waarborg gesien word nie. Die bevinding was dat ons die versekeraar nie aanspreeklik kon hou vir enige skade wat die klaer gely het bloot omdat die polis nie na verwagting presteer het nie.

Die klagte is gevolglik nie gehandhaaf nie maar omdat die brief so onduidelik geskryf is dat dit valse verwagtinge geskep het, is vergoeding ten bedrae van R2 500 in terme van Reël 3.2.5 aan die klaer toegeken.

Derde voorbeeld

Die klaer het in 2001 ‘n bedrag van R400 000 in ‘n enkelpremie uitkeerpolis by versekeraar X belê. Dit was ‘n indeksgekoppelde effek wat bekend gestaan het as die “World Leader 125%”. Volgens die klaer is hy deur die finansiële adviseur en die bemarkingsmateriaal onder die indruk gebring dat die belegging teen 125% sou groei.

Volgens die adviseur het hy verstaan dat die klaer groei sou ontvang wat aan die indeksbeweging gelykstaande sou wees. Hy het ontken dat hy ooit aan die klaer sou gesê het dat hy ‘n 125% gewaarborgde groei sou geniet.

Feitelike geskille word normaalweg deur die Ombudsman se kantoor op ‘n oorwig van waarskynlikhede en met inagneming van die bewyslas besleg. Ons kon nie ‘n bevinding oor die geloofwaardigheid van die partye maak nie en moes dus op die dokumentasie (die bemarkingsmateriaal en polis) terugval ten einde tot ‘n gevolgtrekking te kom.

Na bestudering van die bemarkingsmateriaal, was ons van mening dat die klaer nie redelikerwys die afleiding kon maak dat die belegging “gewaarborg” was om met 125% te groei nie. Die bemarkingsmateriaal het uitdruklik vermeld dat die uiteensetting slegs ‘n voorbeeld was en dat die gefinansierde indeksgroei van 125% slegs ten opsigte van die indeksgroei sou geld (en nie ten opsigte van die oorspronklike kapitaal nie). Dit het ook uit die bemarkingsmateriaal geblyk dat indien daar geen indeksgroei was nie, daar geen gefinansierde indeksgroei sou wees nie.

So gesien, tesame met die feit dat die polis self geen voorsiening vir ‘n gewaarborgde groei van 125% gemaak het nie, was dit ons mening dat die klaer nie redelikerwys onder die indruk kon verkeer het dat die polis ‘n gewaarborgde groei van 125% sou moes toon nie.

Die klagte is nie gehandhaaf nie.

Statisties was klaers die afgelope tyd in ons kantoor in 42% van gevalle in meerdere of mindere mate suksesvol. Maar selfs waar ‘n klagte onsuksesvol is, en die klaer dalk onvergenoegd voel, het hy of sy darem ten minste die gemoedsrus dat ‘n buitestaander die saak objektief bekyk en onbevange beoordeel het.

(Sien ook die Weekend Argus se Personal Finance van 2 Desember 2006, bladsy 3.)