One respondent requested that complaints data be published more often, possibly on a quarterly basis. The request should be considered.
OLTI response: This request was discussed with insurer representatives at a Committee meeting on 15 April 2015 and the general view was that there was no need for quarterly publication. OLTI is of the view that quarterly reports are not needed. The first quarter in particular would give a skewed picture. The preparation and “auditing” of the reports for publication purposes requires a lot of time and effort and we do not think it is justified.
For now annual publication should be sufficient. Insurers, the FSB and National Treasury receive the information on a quarterly basis. Because this information is not made public it does not require the same amount of checking and preparation as the annual publication. We can revisit this issue in the future.
2. Employment of persons who have worked, in the previous three years, for a long-term insurer.
Depending on circumstances, a cooling-off period of anything between six months to two years may be required before any person is appointed to a senior, decision-making position at OLTI.
OLTI response: We agree that this requirement should apply to the Ombudsman and Deputy Ombudsman. The norm is that the Ombudsman should not have worked in the industry in the previous three years.
3. Transfer system
One insurer raised the concern that where for instance a disability claim had already been rejected, there was not much point in transferring the complaint again to the insurer. The concern was expressed that this was not in the complainant’s best interests, as it added an unnecessary time delay to the resolution of the complaint. A slight adjustment to the type of complaint transferred to insurers should address this problem.
OLTI response: This aspect was raised with insurers at the Committee meeting. Insurers did not agree with the concern expressed as the complaints department may in certain circumstances have a different view to that of the claims department of an insurer. OLTI confirmed that insurers are always at liberty to request that a case be regarded as a standard case if they regard that as more appropriate than a transfer.
4. Assistance to complainants, free of charge
The procedure followed by OLTI provides complainants with sufficient assistance and safeguards to canvas any complaint in full, without legal assistance and at no cost. This aspect could perhaps be better publicised.
OLTI response: Agreed.
5. Appointment of Council members
Some consideration could be given to a more transparent process when council members are appointed, including possible public advertisement. Any advertisement should disclose the fact that members of the Council are required to act in the public interest and to act independently.
OLTI response: Agreed.
6. Independence of OLTI
More publicity about the independence of OLTI could be considered, such as the explanation of the independence of the Banking Scheme given on the website of the Ombudsman for Banking Services, at www.obssa.co.za/index.php/about-us/independence-obs
OLTI response: Agreed.
7. Publication of details of OLTI
The website ombud.co.za is written from the point of view of OLTI rather than complainants seeking assistance. The fundamental principles set out in Recommendations 4 and 5 above could be a useful guideline in rewriting at least the introductory page of the website so as to be more complainant driven.
It does not seem to be general knowledge that long-term insurance refers to life insurance. The first item on the first page could be an explanation that long-term insurance is life insurance, which includes disability cover, funeral policies, credit life insurance, etc. If there is any doubt, complainants could be encouraged to contact the general OMBUD helpline 0860 OMBUDS (0860 662 837), or could be advised that if their complaint does not fall within the jurisdiction of the Office, the complainant will be advised accordingly, whilst at the same time the complaint will, free of charge, be forwarded to the appropriate agency.
Although it is mentioned on the website, more prominence can be given to the fact that the scheme is recognised in terms of section 11 of the FSOS Act, that it acts under an independent Council even though it is funded by subscribing insurers; that subscribing insurers are bound by the decisions of OLTI; that compensation orders can be made; that limited awards can be made on the grounds of equity; that the service is free of charge to members of the public; that any complainant can still approach a court of law after exhausting the services of OLTI. The extent of confidentiality could also be set out.
OLTI response: Agreed. We propose that a specialist be appointed to assist with making the website more “user-friendly” for complainants.
8. Publication of contact details of OLTI
- In this regard, it is suggested that the following be added to the existing letter head:
- A statement that the services offered by OLTI are free of charge to members of the public;
- Details of the general Financial Ombudsman Call Centre0860 OMBUDS/0860 662 837;
- The fact that OLTI is recognised by the FSOS Council in terms of section 11 of the Financial Services Ombud Schemes Act, 37 of 2004;
- Membership of the INFO Network (optional).
OLTI response: Agree with points 1 (already done) & 3 and possibly point 4. We do not agree with point 2. This could confuse complainants who would telephone that number instead of our number.
9. Details of scope of jurisdiction
The guidelines that could be implemented by OLTI relate to
- the maximum value of disputes,
- the maximum amount that could be awarded for inconvenience,
- time limits (if any) for the lodging of complaints and
- any grounds on which the ombudsman scheme may decline to deal with a dispute that is in its jurisdiction.
OLTI response: Although the Rules are on our website we will highlight these features.
10. Publication of details of enquiry
Two of the suggestions that could be implemented by OLTI, are publication of the fact that OLTI goes to a lot of trouble to actively investigate cases and the fact that bringing a dispute to the ombudsman scheme does suspend any time limit for taking the dispute to court.
OLTI response: We will highlight this.
11. Accessibility
Long-term insurers are required to advise clients on every policy document of the right to complain to OLTI and to give full contact details of OLTI. This could be extended to include a notification on the insurer’s website, at the point of sale, if the customer makes a complaint and in the insurer’s final written decision on a complaint. The latter should include details of how to contact OLTI and any time limits that apply.
OLTI response: The FSB has a draft protocol for complaints handling. This should be considered together with the current Policyholder Protection Rules before any of these steps are taken.
12. Other sources of information
One staff member, during an interview, suggested that contact details and other basic information be made available on a smallish printed card or in another similar format, for use by staff members when asked about the operation of the Office. She mentioned that for instance during the long taxi ride home to the Transkei, or whilst queuing at a hospital or clinic, she sometimes overheard conversations relating to problems where OLTI could be of assistance. Some literature would be helpful, or business cards with full contact details, made available for all staff members, could be considered.
OLTI response: Agreed.
13. Communication
More publicity could be given to the fact that OLTI goes to a lot of trouble to actively investigate cases and that help is available, if needs be telephonically, in most of the official languages. Where assistance is not immediately available, OLTI undertakes to come back to the complainant within a reasonable time, in the appropriate official language.
OLTI response: Agreed.
14. Free service for complainants
There is no cost barrier to lodging a complaint with OLTI. More publicity could be given to this.
OLTI response: This is contained in our communication channels but we will find other ways to publicise this.
15. Resources
It is suggested that a facility to record telephone conversations, especially difficult or rude conversations, directly onto a PC, could be considered.
OLTI response: We propose to replace our telephone system and will ensure that recording is possible.
16. Staff Training
Some of the areas mentioned in which staff members would like to receive further training or skilling, includes the jurisdiction of OLTI and practical training in dealing with the psychological aspects of calming down and dealing with distressed complainants in a professional manner. The need is for practical skills rather than further formal qualifications, but preferably training by an INSETA accredited institution, for which an attendance certificate is issued. Training should be given to all persons on the same level, possibly in two sessions so as not to disrupt the functioning of the Office. The possibility of receiving a reduction in INSETA levies to help cover the cost of such training, should be investigated.
OLTI response: We will arrange suitable training.
17. Extension granted to complainants
One insurer felt that too much leniency was given to complainants where an extension for submission of further evidence was granted without any request by the complainant for such an extension. It was suggested that an extension should only be granted to a complainant upon request. Implementation of this suggestion should be considered.
OLTI response: Many of our complainants do not have easy access to mail. Where appropriate we are lenient with time limits to ensure that complainants are not prejudiced by this disadvantage.
18. Publication of complaints data
One respondent went so far as to suggest that publication of data be done more frequently, possibly every quarter, as it gave client service departments an opportunity to compare their performance to industry standards. In particular, the wholly or partially in favour of complainants percentages are deemed to be helpful.
OLTI response: See response to point 1.
19. Internal Arbitrators
Whilst it is to be welcomed that an increasing number of insurers have appointed internal arbitrators, the success of the office of internal arbitrator will in each instance depend on the independence, maturity and professionalism of the particular incumbent, and the level of respect the incumbent enjoys, internally as well as externally. Insurers should be encouraged to appoint high calibre internal arbitrators, at senior level, and to give them sufficient independence.
OLTI response: We will communicate this recommendation to insurers.
20. Protection of the Ombudsman for Long-term Insurance
Whilst there are increasing expectations of the role played by voluntary financial ombud schemes recognised by the Financial Services Ombud Schemes Council, some consideration should be given to increased protection for all such voluntary ombud, possibly similar to the protection given to the Pension Fund Adjudicator by section 30V of the Pension Funds Act, 24 of 1956.
OLTI response: We are not certain that this is required. It is a decision for the legislature.
21. Enforcement of determinations
The fact that the enforcement of determinations by the Ombudsman for Long-term Insurance is virtually assured, and that if an insurer fails to comply with a determination, OLTI is obliged to use the powers of enforcement set out in rule 7, could be given more prominence, on the OLTI website and elsewhere.
OLTI response: Agreed.[/vc_column_text][/vc_column][/vc_row]
