Compliance - Regulatory / Life Ombudsman

Ruling by Ombudsman for long-term insurance

An insurer has been ordered to pay a funeral claim that had been declined on the basis that the life insured had reached 21 years because the policyholder had neither been given notification nor the opportunity to pay an increased premium.

Life Ombuzz: Payment in full and final settlement

Insurers sometimes make payments in settlement without advising the claimant prior to payment of the amount which will be paid, and, without obtaining the claimant’s agreement that the payment is in full and final settlement. The following case demonstrates the effect of this omission where the claimant subsequently claims an additional amount.

Ombuzz Issue 27: A change of health after the date of the application

CASE 16: late submission of claim under individual funeral plan

Policy providing submission of claim within six months from date of death; late submission due to personal circumstances and policy unknown to claimant; insurer unable to show specific prejudice if claim admitted; exercise of equity jurisdiction.