The OLTI’s 2018 annual report dealt extensively with the notorious “Ganas case” when Momentum Life rejected Denise Ganas's claim on her husband death policy because he failed to disclose high blood sugar levels when he applied in 2014.
Ganas died in a hijacking in 2017.
Momentum had the law on their side (and the OLTI ruled in its favour), but the company bowed to immense public pressure and paid out the claim.
The OLTI wants insurers faced with "non-fraudulent misrepresentation" to “reconstruct” the policy to what it would’ve been had the misrepresentation not taken place.
The OLTI’s 2018 annual report had harsh words for some insurers.
Alexander Forbes Life – Ordered to pay compensation for causing a client "distress, inconvenience and financial loss". It slammed the insurer’s “incomplete responses and lack of supporting documentation”.
Another insurer only paid a R1000 funeral claim for a stillborn baby after the OLTI mediated.
Sanlam Developing Markets refused a funeral claim after the passing of a “second cousin” who had been labelled as a "cousin" by the claimant. The OLTI ordered the company to pay the claim as the term “cousin” in the market it operates in includes second cousins.