The Office of the Ombudsman for Short-Term Insurance offers consumers a “no risk” mechanism to resolve disputes with insurers. The Office can assist consumers with the following personal lines short-term insurance:
- Motor
- Houseowners (Buildings)
- Householders (Contents)
- Cell phone
- Travel
- Disability
- Credit protection insurance
- Commercial Insurance on a Limited basis, i.e. claimants su
ch as small businesses, including a sole proprietor or trader, a juristic person, partnership or trust that has a turnover in the last financial year of less than R25 million. Claim disputes, which the Office can assist with, include fire and allied perils, glass, theft, motor, travel, sickness and accident and SASRIA claims (affiliated to the aforesaid covers). The Office of the Ombudsman for Short-Term Insurance has been granted recognition in terms of the provisions of the Financial Services Ombud Schemes Act. Personal lines short-term insurers, who are members of this office, have agreed to abide by the Ombudsman’s decision. The Ombudsman’s task is to act as a “mediator” or informal arbitrator and he/she does not represent either of the parties to the dispute. Important points to remember:
- You must complain to your insurance company first and only if you are unable to resolve the dispute with your insurer, then you can refer the matter to the Ombudsman’s Office.
- The Ombudsman’s decisions are binding on the insurance company but not on you.
- The Ombudsman’s Office is an independent office.
- The Ombudsman’s decisions can be based on law and equity.
- The Ombudsman’s Office does not give legal advice.
- The service is free to insured consumers
The office for the Ombudsman for Long-term Insurance was established in 1985. The function of the office is to mediate in disputes between subscribing members of the long-term insurance industry and policyholders regarding insurance contracts. It is an independent office which is accountable to an independent Long-term Ombudsman Council for providing an efficient and independent service to policyholders and others in response to disputes arising from long-term insurance policies. Policyholders who submit a complaint to the Ombudsman may still decide to follow the conventional civil justice process, although these two processes are not allowed to proceed simultaneously. The service is free to complainants. Industry subscribers are bound by the Ombudsman’s rulings. There is provision in the rules for an informal appeal process. In achieving its mission, the office strives towards: Informality; ready access; cost effectiveness; speedy resolution of disputes; mediation rather than adjudication; and the right to afford due weight to equity. Any policyholder, a successor in title, beneficiary, life insured or premium payer of a long-term or life insurer who subscribes to the Ombudsman scheme, can lodge a complaint. We commonly receive complaints relating to:
• Conclusion of contracts of insurance
• Interpretation of proposal forms and policy provisions
• Life policies
• Disability benefits
• Annuities
• Funeral benefits
• Credit life insurance policies
• Health policies
• Rejection of claims by insurers because of:
o non-compliance with policy provisions
o pre-existing conditions
o non-disclosure
o fraudulent claims
• Cancellation of policies by policyholders because of:
o Misrepresentations
o Lapsing and re-instatement of policies
o Communication, administration and other errors by insurers
o Policy values
