Long-term Ombud Annual Report 2015

The office of the Ombudsman for Long-term Insurance (OLTI) needs to be commended for the quality and simplicity of its 2015 annual report. Below are some interesting extracts from the report.

General overview

In last year’s Annual Report it was pointed out that, despite the continued existence of the trends which could have been responsible for the consistent increase in the number of complaints received during the past few years, the office received nearly 8% fewer written requests for assistance in 2014 than in 2013. I then said that it would be premature to forecast any complaint trend for 2015, but the tenor of my statement was that a further reduction in the number of complaints could be expected. It was prudent not to have made a forecast because it would have been wrong. The office experienced a marked increase in the number of complaints received during the last quarter of the year and this resulted in a build-up of current cases at the end of 2015.

New Business Model

The essence of the office’s new business model is its requirement that any complaint not previously considered by a subscribing member will be forwarded to it in the first instance with a view to affording it an opportunity to resolve the complaint. In 2013 the new business model started as a pilot project involving a few insurers and during 2014 it was incrementally expanded to other subscribing members. As matters turned out, 2015 was the first year for which a meaningful comparison could be made with a previous year. On page 12 of our 2014 Annual Report an analysis was done of the 2014 Transfers, namely those matters which had been sent to the insurers by the office. This year the same analysis appears on page 14 of this Annual Report and the 2014 analysis is also reflected there for comparative purposes. It will be seen from this comparison that the pattern of the Transfers over those two years is quite consistent.

We quite like this model as it ensures that the public is protected from what might appear to be conflicts of interest for internal ombuds.

Independent External Review Feedback

This review, conducted by Dr ER De la Rey (see article below) made recommendations for the improvement of the way in which the office functions and of the service which it renders to consumers. Her principal recommendations (agreed to by the office and implemented or in the process of being implemented) include:

  • Publicity should be given to the fact that procedures provide complainants with sufficient assistance and safeguards to canvass any complaint in full, without legal assistance and at no cost.
  • More publicity should be given to the independence of the office.
  • The website should be more-user friendly for complainants, more prominence should be given to the independence of the office, that compensation may be awarded, that it has an equity jurisdiction and that its services are free.
  • The lodging of a complaint suspends any time limit for taking the dispute to a court of law.

Unreasonable complainants

There was a steady increase in the number of unreasonable complainants and in the number of complex complaints. By all accounts this appears to be a worldwide phenomenon. We also find that there seems to be a correlation between unusually persistent complainants and complex complaints.

The reasons for unreasonable conduct include anger, frustration and an exaggerated sense of entitlement. Some complainants claim to be seeking “justice” or “a moral outcome” and they often appear to focus rigidly on a “principle”. We have had complainants who appear to enjoy driving their complaints. One of them kept a tally of the number of hours he spent working on the complaint. It had reached over 400 hours before a final determination, dismissing his complaint, put an end to what appears to have been a pleasurable pastime.

I was tempted to use this part of the annual report in the humour section of our newsletter. We all know those difficult customers whom I used to refer to as “Stry Doms” in my day.

Please click here to download the full Annual Report.

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