In this episode of "Know Your Ombud," we examine the complexities of long-term insurance and the common complaints the Ombud receives.

Host Maya Fisher-French chats to Sonya Marais, Senior Adjudicator for the Life Insurance Division of the National Financial Ombud (NFO), about the intricacies of insurance claims, particularly focusing on the challenges surrounding non-payment of claims and non-disclosure. Sonya explains the distinction between advice-related issues and product failures, and how these factors influence the adjudication process.

Listeners will hear case studies, including an example of a driver who lost his eyesight and faced rejection of his claim due to the insurer's interpretation of disability. Sonya explains the Ombud's role in evaluating the fairness of such decisions, emphasising the importance of understanding the terms and conditions of insurance policies.

The conversation also addresses the often-overlooked nuances of funeral policies and why you cannot take out funeral cover on someone who is not directly related to you. They also discuss the potential for fraud in the industry. 

Join Maya and Sonya as they navigate the challenges faced by consumers in the long-term insurance landscape, reinforcing the message that the Ombud service is a free and accessible resource for those seeking resolution in their insurance disputes. Remember, understanding your rights and responsibilities is key to ensuring fair treatment in the financial services sector.

If you feel let down by a financial provider, contact one of these Ombud schemes:

- FAIS Ombud for financial advice disputes – faisombud.co.za

- Office of the Pension Funds Adjudicator (OPFA) for pension fund related disputes – pfa.org.za

- JSE Ombud: JSE-related issues – jse.co.za

- National Financial Ombud Scheme (NFO) for banking, credit, and insurance – nfosa.co.za

This series was created in partnership with The Ombud Council.