Long-term Insurance Ombudsman to publish determinations for the first time

The Ombudsman for Long-term Insurance will in future make public all determinations issued against long-term insurers. This follows a recent amendment to the Rules applicable to the Office of the Long-term Insurance Ombudsman, which previously protected the identities of life insurers with a strict confidentiality clause.

Judge Brian Galgut (pictured), the Ombudsman for Long-term Insurance, says in terms of the rule change he is now obliged to make public the name of the long-term insurer against which the determination was issued, together with a summary of the case and the reasons for the decision. The identity of the complainant, however, may not be disclosed.

Galgut points out that the rule change applies only to final determinations, which means that the details of long-term insurers party to settlements or provisional determinations will still not be disclosed.

The rule was changed earlier this month at the request of the Financial Services Ombud Schemes (FSOS) Council, and in line with the national and international trend towards greater transparency.

Galgut says the rule change will not result in a flood of published determinations since there are very few final determinations made against insurers. “On average 44% of all complaints are resolved wholly or partially in favour of complainants. By far the majority of these resolutions are achieved by mediated settlements.”

Galgut explains that most insurers settle when presented with a provisional determination, negating the need for a final determination. “The aim of the provisional determination is to provide the losing party with the opportunity to furnish any facts or submissions that have not previously been presented and that might have an impact on the outcome of the case. But insurers generally accept the provisional determinations and offer settlements in terms thereof.”

Determinations will be published on the website of the Long-term Insurance Ombudsman on http://www.ombud.co.za/ and included in the newsletters issued by that office. Depending on the significance of the determination, the Long-term Insurance Ombudsman may also issue a media release.