The Question is "Should Insurers Continuously Update Policyholder Records"? Insurance Law Requires the Principles of Administrative Law to Settle Disputes between the Policyholder and the Insurer

Authors

  • Neels Kilian Faculty of Law, NWU

DOI:

https://doi.org/10.17159/1727-3781/2019/v22i0a6386

Keywords:

Financial Services Tribunal, Insurance, FAIS Ombud, OSTI, fraud, public function, policy holder records, reconsideration, insurance law, Financial Sector Regulation Act, duty of disclosure

Abstract

It is possible to argue that the Financial Advisory Intermediary Services Ombud (hereafter FAIS Ombud) has jurisdiction to consider insurer's decisions not to update their internal administrative systems. The FAIS Ombud may therefore investigate such matters as a complaint as defined in section 1 of the Financial Advisory and Intermediary Services Act 37 of 2002 (hereafter the FAIS Act). On the other hand, upon any failure to investigate such complaints, the complainant may approach the Financial Services Tribunal, either to give directions to the FAIS Ombud regarding how to investigate the complaint or to replace this failure with the Tribunal's own investigation/reconsideration of a decision as regulated in section 8 of the Promotion of Administrative Justice Act 3 of 2000 (hereafter the PAJA). An administrative decision is defined in the Financial Sector Regulation Act 9 of 2017 (hereafter the FSRA) which includes the statutory ombud (example, FAIS Ombud) decisions, such as a decision not to investigate a complaint. When an insurer's decision is in fact an administrative decision, reference should also be made to the FSRA, i.e. an insurer's decision to debar an employee/representative or a decision not to update relevant policyholder records with new information. An insurer's decision not to update policyholder records is not part of this statutory regulation (FSRA) of what constitutes an administrative decision; nevertheless the PAJA could still be relevant to understand when these decisions could be considered a public function. Although the latter falls outside the scope of this article, the National Horse Racing Authority of Southern Africa v Cyril Naidoo 2010 3 SA 182 (N) is briefly discussed in this article with reference to a public function. In this article, the failure of the FAIS Ombud to investigate a policyholder's (hereafter client) complaint (the insurer is unwilling to update client records) is an administrative decision and it is specifically regulated by FSRA. For this reason, the relevance of the Financial Services Tribunal is discussed when the FAIS Ombud directs the complaint (or the client may also refer a matter in specific circumstances, as if the FAIS Ombud fails to investigate the matter within a reasonable time) to the Financial Services Tribunal for a reconsideration of the decision.

 

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References

Burns Y Administrative Law (LexisNexis Butterworths Durban 2013)

Church J "Jerrier v Outsurance Insurance Company Ltd 2013 JDR 0562 (KZP) - The Duty to Disclose: An Ongoing Problem?" 2013 De Jure 859-868

Donnelly D "Do you Always Get Something Out? The Impact of the Insurance Act 18 of 2017 and Revised Policyholder Protection Rules on Material Misrepresentation and Non-Disclosure" 2018 SALJ 593-612

Godwin AJ and Schmulow AD "The Financial Regulation Bill in South Africa, Second Draft: Lessons from Australia" 2015 SALJ 756-768

Grote R "The Scope of Judicial Review of Administrative Action and the Changing Rule of Law: Some Comparative Reflections" 2004 SAPL 513-531

Henrico R "Subverting the Administrative Justice Act in Judicial Review: The Cause of Much Uncertainty in South African Administrative Law" 2013 TSAR 288-307

Hiemstra VG and Gonin HL Trilingual Legal Dictionary (Juta Cape Town 2000)

Institute of Directors Southern Africa King IV Report on Corporate Governance for South Africa (Institute of Directors Southern Africa Sandton 2016)

Kilian CG (ed) Financial Services Board Directives 2000-2015 (Sunmedia Pretoria 2015)

Kloppers H "The Regulation of Advice within the Financial Services Sector" 2007 Obiter 133-142

Kohn L "Our Curious Administrative Love Triangle: The Complex Interplay between the PAJA, the Constitution and the Common Law" 2013 SAPL 22-93

Malherbe EFJ "Privatisation and the Constitution: Some Explanatory Observations" 2001 TSAR 1-15

Millard D and Kuschke B "Transparency, Trust and Security: An Evaluation of the Insurer's Precontractual Duties" 2014 PELJ 2411-2450

Pečarič M "Administrative Law: Indefinable, but Necessary and very Much Alive" 2016 SAPL 91-113

Saunders C "Apples, Oranges and Comparative Administrative Law: Practical Steps" 2006 Acta Juridica 423-449

Van Heerden M "Promotion of Administrative Justice Act 2000: Three Types of Administrative Actions" 2009 Journal of Public Administration 183-195

Van Niekerk JP "Goodbye to the Duty of Disclosure in Insurance Law: Reasons to Rethink, Restrict, Reform or Repeal the Duty" (Part 1) 2005 SA Merc LJ 150-169

Van Niekerk JP "Goodbye to the Duty of Disclosure in Insurance Law: Reasons to Rethink, Restrict, Reform or Repeal the Duty" (Part 2) 2005 SA Merc LJ 323-339

Construction Men at Work CC v KRDS Insurance Brokers FSOS 00458-12/13/KZN 3

David Jackson Mbetse v Pieter De Wet FSOS 00132/13-14/GP3

Diandra Laura Adams v Horn Carstens FSOS 00086/16-17/WC 3

Emile de Beer v SAPCOR Broking Services FSOS 04761/11-12/FS3

Gert Goeiman v Rekathusa Funeral Parlour FSOS 00340/14-15/NW 2

Michelle Collard v Henry Grundling Makelaars CC FSOS 00750/11-12/GP3

Quintainie CC v Sencla Financial Services FOC 2460/07-08/GP3

Swanepoel v Outsurance Insurance Company FAB 71/2018 unreported reconsideration of decision

Swanepoel v Outsurance FSOS 02742-18/19-GP 3 unreported determination

Van der Merwe v Forum SA Trading FSOS 05474/14-15

Basson t/a Repcomm Community Repeater Services v Post-Master General 1994 3 SA 224 (SE)

Cape Metropolitan Council v Metro Inspection Services Western Cape CC 2001 3 SA 1013 (SCA)

Herbert Porter & Co Ltd v Johannesburg Stock Exchange 1974 4 SA 781 (W)

Johannesburg Stock Exchange v Witwatersrand Nigel Ltd 1988 3 SA 132 (A)

National Horse Racing Authority of Southern Africa v Cyril Naidoo 2010 3 SA 182 (N)

Pennington v Friedgood 2002 3 BCLR 298 (C)

President of the RSA v SARFU 2000 1 SA 1 (CC)

S v Swanepoel (Gauteng Regional Court Division) (unreported) case number 44/07/2011

Tristar Investments (Pty) Ltd v The Chemical Industries National Provident Fund 2013 ZASCA 59 (16 May 2013)

Van Zyl v New National Party 2003 10 BCLR 1167 (C)

Conduct of Financial Institutions Bill 2018

Constitution of the Republic of South Africa, 1996

Financial Advisory and Intermediary Services Act 37 of 2002

Financial Sector Regulation Act 9 of 2017

Promotion of Administrative Justice Act 3 of 2000

Short-Term Insurance Act 53 of 1998

Vexatious Proceedings Act 3 of 1956

GN 1433 in GG 41329 of 15 December 2017 (Replacement of Policyholder Protection Rules)

Uniform High Court Rules

FSCA 2018 https://www.fsca.co.za/Pages/Default.aspx

Financial Sector Conduct Authority 2018 Home Page https://www.fsca.co.za/Pages/Default.aspx accessed 1 September 2018

Financial Sector Conduct Authority 2019 https://www.fsca.co.za/

Enforcement-Matters/Financial%20Services%20

Tribunal/Financial%20Services%20Tribunal%20Rules%20-%201%20

August%202019.pdf

Financial Sector Conduct Authority 2019 Financial Services Tribunal Rules https://www.fsca.co.za/Enforcement-

Intersoft Consulting 2018 https://gdpr-info.eu/issues/right-to-be-forgotten/

Intersoft Consulting 2018 GDPR – Right to be Forgotten https://gdpr-info.eu/issues/right-to-be-forgotten/ accessed 10 May 2018

National Treasury 2017 A Known and Trusted Ombud System for All http://www.treasury.gov.za/twinpeaks/Final%20Twin%20Peaks%20Policy%20Doc_A%20known%20and%20trusted%20ombuds%20system%20for%20all_September2017.pdf accessed 14 August 2018

Published

25-10-2019

How to Cite

Kilian, N. (2019). The Question is "Should Insurers Continuously Update Policyholder Records"? Insurance Law Requires the Principles of Administrative Law to Settle Disputes between the Policyholder and the Insurer. Potchefstroom Electronic Law Journal, 22, 1–24. https://doi.org/10.17159/1727-3781/2019/v22i0a6386

Issue

Section

Notes