How does the insurance ombudsman procedure work in South Africa?
The Office of the Ombudsman for Short Term Insurance of South Africa, was formed and established by government charter in 1989 to provide complimentary and quick relief to customers and their insurance companies when they are both in dispute, on matters relating to insurance agreements between the two. Ombudsman insurance – short term insurance – South Africa. The purpose of the Ombudsman is to resolve disputes between members and insures consumers in an independent, impartial, cost-effective, efficient, informal and fair way
So if you are not happy with the way your complaints to your insurer are handled and resolved, you have the onus to complain to the Insurance Ombudsman and seek relief.
Either you or the car insurance company could file a complaint with the Insurance Ombudsman and they would act as arbitrator and mediator acting independently and impartially to ensure that justice prevails for those affected.
The decisions of the Insurance Ombudsman are binding on both parties to the dispute and is a way to help those affected due to actions of car insurance companies who could be callous and stubborn in their attitudes when dealing with issues within the agreements that they would see as detrimental to their interests.
There are always two sides to the coin, insurance fraud in South Africa is at unprecedented epidemic levels and when insurance companies have seen into all angles and are satisfied with the bona fides of the claim, that they will pay out and until they are convinced would hold payment back.
If there is reason to believe that your dispute is reasonable then you could make a formal complaint to the Insurance Ombudsman and seek relief but to do that you would need to comply with its strict procedures.
It is imperative that you initially make a formal complaint to the car insurance company that you are in dispute with, prior to taking your complaint up to the Insurance Ombudsman.
- The services of the Ombudsman are free to insured consumers.
- You should always complain first to the insurance company you are insured with and, if the dispute can not be resolved with your insurers, then only can you bring your dispute to the insurance Ombudsman.
- The decisions made by the insurance Ombudsman are binding, compulsory only on the insurance company not on you side.
- You are not compiled bound to any decisions made by the Ombudsman, this meaning that if you are still unsatisfied you have the right to take your dispute to court.
- The insurance Ombudsman South Africa is an independent office.
- Decisions are based on either law or equity.
- The Ombudsman does not give out legal advice.
The Ombudsman can quickly help resolve your insurance disputes especially when you have a strong case against your insurance provider.
What would you need to do:
- Make the complaint in writing keeping a record with you.
- By chance it is a telephone complaint note down all details of the conversation, date, time and persons etc, if possible keep a recording of the conversation.
- Facts of the subject matter should be very clearly visible to a third party, hence be precise and to the point.
- Be polite in conversation and ensure that you do not lose your cool as it would be in your best interests to show calm when you are to present it to the Insurance Ombudsman at a later date.
- You need to show the Insurance Ombudsman that you have tried all avenues possible with the car insurance company and have not been able to resolve the dispute.
Formally complaining to the Insurance Ombudsman
Submit the completed complaint application form either by post, email, facsimile or online but remember to attach all relevant documentation relevant to the complaint.
Retain copies of the official complaint that you have submitted and all the relevant documentation with you because you would be called upon to submit then at a subsequent inquiry and if you are unable to remember all the details write the issue down step by step as to what transpired between the car insurance company and you.