Many gripes over funeral policies: ombud

In 2010, 33 percent of complaints related to funeral policies.

The office received a similar number of complaints last year, 9,195, as in 2010, when 9,215 complaints were received.

A total of 40 percent of all cases were resolved wholly or partially in favour of complainants, down from 46 percent in 2010, according to the report.

During 2011, 58 percent of finalised cases were marked as claims declined. This category has been the largest category for the last eight years, as well as the largest growth area.

Insurers are now required to advise consumers that they have the right to lodge complaints with the office when their claims are denied, according to the report.

The ombudsman noted that consumers were frequently unaware of what their insurance policy covered, particularly in respect of health policies.

Insurance products could be promoted in a misleading way. An advert could inform consumers they were not required to undergo a medical exam when applying for cover, creating the impression that this was an advantage of the product. But where insurers did not require medical exams as a pre-requisite for cover, they would usually exclude pre-existing medical conditions.

Health policies could also contain unclear wording. While they contained medical terms out of necessity, even if these were accurate and clear to doctors, they might not necessarily be for lay consumers.

"A policyholder might therefore be covered for a heart attack or cancer, but might find out at claim stage that because of the definition of the conditions his particular heart attack or cancer is not necessarily covered," the ombudsman's office said.

But policies where the medical wording was itself unclear or insufficient presented a greater problem.