Familiarize yourself with these insurance claim tips to speed up your claims process

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DURBAN – Hollard Life Solutions Chief Operating Officer Kabelo Gude says according to the 2020 Annual Report of the Ombudsman for Long-Term Insurers (OLTI), the Ombudsman received 14,198 requests for assistance in 2020, with 6,756 billable complaints.

Gude explained that a billable complaint was a complaint that had been reviewed by an organization as part of its internal processes for consideration. Among these, 1,373 cases, or 32% of the cases filed, were settled in favor of the complainants.

During the period under review, the Mediator received 456 complaints directly related to Covid-19 or to containment, the majority of which (36%) concerned borrower insurance benefits, while disputes relating to funeral cover represented 42 % of all complaints received by the office that year.

Gude pointed out that the most common complaints to long-term insurers over the past 18 months were about miscommunication, failure to provide necessary information, and dismissal of claims.

“Now more than ever, it is essential for consumers and policyholders to familiarize themselves with their policies, ensure their premiums are up to date, understand exemptions and exclusions and know what their policies cover. Simply submitting certain documents to an insurer does not necessarily mean that a claim will be paid. Each type of complaint has different requirements and can be assessed differently, ”explains Gude.

“The death toll in South Africa from Covid-19 currently stands at just over 86,000, according to the national health ministry, and we have seen some concerns expressed by policyholders resulting from a lack of understanding of the complaints process. That’s not to say the majority of claims go unpaid – in fact, Covid-19 has seen Hollard pay record amounts in death benefits, with just over R3.6 billion paid to date.

“To ensure an efficient claims process, it is important that policyholders know how to make a claim. The most common mistake made by policyholders is not submitting all the necessary documents. Supporting documents are very important in establishing the veracity of a claim, and these documents help speed up the claims process, ”said Gude.

He added that assigning third parties to file a claim on behalf of an insured may impact the outcome of the claim, as each claim is assessed on its individual merits.

The insurer said the pandemic has put many consumers under financial pressure, and they noted that many consumers have started not paying their insurance premiums to free up limited financial resources.

Gude warned the public that most funeral policies lapsed after three missed payments.

He said: “At Hollard, policyholders who choose to reinstate their funeral policy within three months of the effective expiration date are not subject to any waiting period and premium arrears are not due, but it can. not be the case with all insurers. Again, it is essential for policyholders to understand what their particular policy says regarding reinstatement.

“We understand the financial pressure many consumers face, and that it has been exacerbated by Covid-19. While we understand that many pressing priorities are fighting for a share of the wallet, the pandemic has taught us the importance of having active insurance coverage because of the safety net it offers your loved ones.

“We encourage consumers who are struggling to keep up with their premiums to consider reducing their payments and coverage to ensure they can maintain coverage. Insurance is important, but significance is only realized when the unpredictable happens, ”said Gude.

MERCURY


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