OMBUD COUNCIL ANNUAL REPORT 2024/25

PART B: PERFORMANCE INFORMATION

2.4.2 OFFICE OF THE PENSION FUNDS ADJUDICATOR (OPFA)

LIFE INSURANCE DIVISION: Funeral benefits remain the product most complained about accounting for 45% of complaints, and claims being declined the most common cause for complaints (56%), followed by complaints about poor service or administration (34%). The Ombud Council is participating in the FSCA and Prudential Authority’s inter-regulatory Funeral Insurance Project, launched to review the funeral insurance framework, aimed at establishing a fairer, more accessible and better-supervised regulatory framework for this sector. NON-LIFE INSURANCE DIVISION: Motor vehicle insurance made up the largest complaint category, accounting for approximately 42% of all complaints in the Division. Key issues identified in motor insurance included accident claims, warranty disputes, as well as theft. Homeowners’ claims were predominantly linked to natural events and burst water systems. Many complaints across categories involved claim rejections which were based on exclusions such as lack of maintenance, gradual deterioration and policy terms not having been met. Common dissatisfaction themes included poor service, delays, premium non-payments, disputes over settlement amounts and the lack of clear advice. A prevalent cause for claim rejections is failure to adequately maintain the insured vehicle or property concerned. The Ombud Council is engaging with the NFO to seek more insight into whether this trend is due to stricter application of these policy provisions by insurers, affordability constraints on the part of policyholders, or a combination thereof.

The nature of complaints dealt with by the OPFA, which frequently entail legislative contraventions, results in the OPFA issuing a significantly higher proportion of final determinations (as opposed to resolving matters through conciliated settlement) than other ombud schemes. The highest complaint volumes continue to arise from employers’ contraventions of their obligations to pay required contributions to funds, which in turn impacts withdrawal and other fund benefits. Complaints relating to the payment and allocation of benefits following a member’s death showed an increase. There was an increase in complaint volumes triggered by the implementation of the two pot retirement benefit withdrawal system. Of the total of 9815 enquiries received by the OPFA during the reporting period 1666 enquiries received between September 2024 and March 2025 related to the two-pot retirement system. Many of these callers reported, for the first time, that their pension fund contributions had not been paid - an issue uncovered when they attempted to access their two-pot withdrawal benefits.

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OMBUD COUNCIL ANNUAL REPORT 2024/25