annual report 2018 - osti.co.za · 10 OSTI ANNUAL REPORT 2018 logo is a modern and simple corporate...

OSTI ANNUAL REPORT 2018 1

annual report 2018

9 779FORMAL

COMPLAINTS RECEIVED 9 474

FORMAL COMPLAINTS

CLOSED

104 DAYS AVERAGE TURNAROUND

TIME

4 026PRELIMINARY COMPLAINTS

RECEIVED

R87 250 982AMOUNT

RECOVERED

88 421CALLS

RECEIVED BY CALL CENTRE

key figures as at 31 December 2018

$


about usWe resolve disputes between consumers and short-term insurers:

• inacooperative,efficientandfairmanner;

• withminimumformalityandtechnicality;• astransparentlyaspossible,takingintoaccountourobligationsforconfidentialityandprivacy.

Thisinvolvesunderstandingallaspectsofadisputewithouttakingsides,andmakingdecisionsbasedonthespecificfactsandcircumstancesofeachdispute.

mission

To resolve short-term insurance complaints fairly,efficientlyand

impartially.

4 OSTI ANNUAL REPORT 2018


contents06 ReportbytheChairman

08 ReportbytheOmbudsman

12 Collaboration Breeds Success

16 Finance Matters

18 OfficeStatistics

20 AStatisticalAnalysisofMattersClosedby

OSTI in 2018

24 ExplanatoryNotesandInsurerStatistics

28 Time Bar

30 Because I said so…

31 OSTI News

32 InterveningInsuredPerils:anApplication

ofEquity

33 NoCover-MaterialChangeinRisk

34 BoardofDirectors

35 StaffoftheOmbudsman

36 TermsofReference

41 OSTI’sInternsonConsumerLiteracy

42 MembersoftheOmbudsmanScheme

43 UsefulInformationaboutOtherOffices


When I presented my first report last year, I made

mention of the organisation’s achievements and its

continuedpurposeinachanginginsurancelandscape.

OSTI’sroleisnottoresolvecomplaintsinthequickest

time period. Neither is its role, year-to-year, to

improve theoverturnrate.TheroleofOSTI, likeany

other independent Ombudsman operating within a

framework of statutory regulation, is to implement

justice and fairness in a process directed towards

a resolution. The key responsibility of OSTI is to

maintain a balance between the powers and duties

of the insurer,ontheonehand,andtheconsumer’s

rightsandobligationsontheother.Inanenvironment

where the financial sector lives under persistent

mistrust, those involvedcanonlybeheld toaccount

byanindependentinstitutionlikeOSTI.

OSTI’s ambition, supported by the board and the

Ombudsman, Deanne Wood, and her team, was to

present itself as an efficient and effective, industry

relevant, reliable and independent dispute resolution

process.

OSTI is now proudly an independent organisation,

achieving a consistently measured and efficient

resolutionofcomplaints,withmostimportantlyahigh

quality in those outcomes. As an organisation OSTI

delivers fair and just outcomes, and this is a tribute

to the administrative and professional skills, the

admirable teamwork and the wisdom and dexterity

ofallthosewhoseenergyoverthepastfewyearshas

ensured a successful organisation. OSTI has shown

thatitisnotonlyforpowerfulpeopleororganisations.

Itisanorganisationforeveryone.

TheTwinPeaksmodeloffinancialregulationinSouth

Africa gave rise to a discussion on how the ombud

systemcanbemadebetter.Thefuture isuponus. It

hopestoseeasingleInsuranceOmbudsmanScheme.

Thiswillgiverisetoonecombinedentryandexitpoint

forallinsurancecomplaints.Theexistingschemes,OSTI

and OLTI, will remain in existence and, importantly,

continue to operate separately within their defined

objectives. There will be no cross-subsidisation

or cross-population between OSTI and OLTI. The

governance of the single Insurance Ombudsman

“Statistics are important, but they serve no more than a guide informing OSTI of its achievements.”

Haroon Y LaherChairman of the Board

report by the chairman

REPORT BY THE CHAIRMAN 7

Scheme will be undertaken by a single board with

representation frombothOSTI andOLTI. The future

isexciting…

2018alsosawchangeintheintroductionofanewIT

systemandOSTI’s new logo. Thenew IT systemhas

improved accessibility to OSTI, and the manner in

whichitcandeliverefficientandqualityoutcomes.

Before I sign off, it is important that I take time to

mention an internship programme introduced into

OSTIbyDeanne.Thisprogrammehasbeendrivento

great success by Deanne’s passion. In January 2019,

OSTI welcomed four new interns, all of whom hold

legal degrees. Through the internship programme,

OSTI provides interns with experience, lessons and the

toolsfortheirfuture.

In short, a lot is happening. OSTI’s board and

management remain engaged in bringing about a

moresuccessfulorganisation.

Haroon Y LaherChairman of the Board

21 April 2019


What an incredible year 2018 was for OSTI! In the

ever increasingly short space of a single year OSTI

transformed almost every aspect of its existing

business.Ittookanin-principledecisiontomergewith

theofficeoftheLong-TermInsuranceOmbudsmanto

create a single scheme for all insurance complaints,

transitioned to a paperless complaints handling

environment, initiated automation enhancements to

its IT processes, redesigned its complaints handling

procedures, changed the way in which it reports

insurerstatistics,rebrandeditscorporateimage,took

up occupation in fresh new premises in Rosebank,

launchedaninternprogramtoadvancethecareersof

younggraduates,establisheda customerexperience

department measuring OSTI’s performance from

the perspective of the consumer and effected

improvements to its internal structures and staff

management.Thatisalotofchangeandnewnessto

dealwithinasingleyear.

Before detailing these new aspects of OSTI’s

business I must pause to commend OSTI’s staff for

the enthusiastic and professional way in which they

embraced and adapted to these transformations. It

was not always easy and there were many hurdles

toovercomealongtheway.But, in theend, through

teamwork, persistence, resilience and large servings

of patience, extraordinary achievements weremade

acrosstheentirespectrumofOSTI’soperations.

Merger with Long-Term Insurance OmbudsmanAt the start of 2018, and in anticipation of the new

regulatoryand legislative frameworkwithinwhichall

financialsectorombudschemeswillsoonbeexpected

tooperate,OSTIinitiatedanin-principleagreementwith

theLong-TermInsuranceOmbudsmantoamalgamate

thetwoschemesintoasingleInsuranceOmbudsman

Scheme. This proposal hasbeenendorsedbyOSTI’s

boardandbyitsstakeholdersanditisanticipatedthat

thenewsingleschemewillbeginreceivingcomplaints

inthelatterpartof2019.

Paperless complaints handling and IT enhancementsLawyersarenotorioususersofpaperandthosewho

choose toply their tradeat theOmbudsmanareno

different.Priorto2018thefirstaspectanyvisitor

to the engine room at OSTI would notice was the

extraordinary amount of paper surrounding and,

at times, engulfing, its workforce! During 2018 OSTI

shifted into a new technological dimension with its

paperlesscomplaintshandlingsystemandautomated

administrativeprocesses.Withina fewmonthsof its

implementationtheubiquitousbulgingfilesthatwere

previously so characteristic ofOSTI’s operations had

Deanne WoodOmbudsman

report by the ombudsman


disappeared.Considering that OSTI has in excess

of3000openfilesatanyonetime,this isadramatic

changeto the landscapeof itsworkingenvironment.

Darpana Harkison (Senior Assistant Ombudsman)

and Marilize Blignaut (Project Coordinator) are

commendedfortheenormouscontributionthatthey

madetomakingthistransitionpossible.

New complaints handling processInacontinuedefforttoimproveitsserviceofferingOSTI

spentaconsiderableportionofitsfocusduring2018

designing a new complaints handling process.Many

aspectsofthenewprocesswerepilotedduring2018

inordertoensurethatitsimplementationwitheffect

from1January2019wasmetwithaslittledisruption

to the organization as possible. Key aspects of this

new process include a better complaints capturing

systemtoensurethatOSTIisabletoprovidetimeous

assistancetoallcomplaintsfallingwithintheambitof

itsjurisdiction,atransferprocesswhichallowsinsurers

an opportunity to resolve complaints internally

before interventionbyOSTI if theyhavenot yethad

the opportunity to do so, an efficient and effective

fast-track process to resolve complaints capable of

swiftdetermination,greaterfocusonconciliatedand

mediated outcomes and finally, a revised escalation

process.1

Insurer statisticsLast year I raised a concern about theway inwhich

insurerstatisticswerereportedandinterpretedbythe

media, industry and consumers. It is perhapsworth

mentioning, yet again, that statistical results are not

necessarilyindicativeofperformance.Thus,aninsurer

whoscoresalowoverturnrateorhasalownumberof

complaintssubmitted to thisoffice isnotnecessarily

“thebestinsurer”.Conversely,ahighscoreineitherof

theseareasisequallynotnecessarilyanindicationof

poorperformancebyaninsurer.Inanefforttobreak

theentrenchedthinkingaroundinsurerstatistics,and

in the hope that it will encourage more conciliated

outcomesOSTIhaschangedthewayinwhichitreports

itsinsurerstatistics.Inthisyear’sreportthestatistics

reveal the number of matters where the insured

receivedsomebenefitasaresultofOSTI’sintervention

(formally described as the overturn rate”) in two

separateparts.Thefirstpartrelatestomatterswhere

resolution was received consensually and through

discussionorconciliationwiththeinsurer.Thesecond

part reflects thosematterswhereOSTIwas required

tomakeaformalrecommendationorrulinginorder

tocompelcompliancefromtheinsurer.

New premises

In July 2018 OSTI moved from Sunnyside Office

Park in Parktown to its new premises at 1 Sturdee

Avenue,Rosebank.OSTIisnowmorecentrallylocated

and has easier accessibility from the Gautrain and

othermajor transport routes. Thenewpremise also

gave OSTI an opportunity to create amoremodern

working environment for its staff and to improve

the communal facilities and general infrastructure.

SpecialthankstoOSTI’sstaff,inparticular,AbriVenter

(assistant ombudsman) and Marilize Blignaut, for

theextraordinaryamountofwork that theyput into

makingthemovehappen.

Rebranded corporate imageCapitalizingonthemovetonewofficesOSTIrebranded

and created a more modern logo. The new OSTI

REPORT BY THE OMBUDSMAN 9

1 AflowchartdetailingthisprocessisavailableonOSTI’swebsite.


logo is amodern and simple corporatemark which

communicates the core values and services provided

byOSTIusingagraphiceyetosymbolizethewatchful

eyeofOSTI.This,combinedwithgeometricdiamond

shapes, symbolises fairness and equality through

symmetry.

Intern programAt the start of 2018 OSTI launched a new intern

programtoprovidelawgraduatesaspiringtobecome

advocates with an opportunity to acquire much

needed legal experience in order to enhance their

applications for admission to the Johannesburg Bar.

ThreesuchinternswereadmittedintoOSTI’sprogram

during 2018, Fatima Missi, Katleho Rudolph Leseba,

SibusisoMagxaki.

I am very grateful to the JohannesburgBar for their

willingnesstoassistOSTIinestablishingthisprogram.

OSTI’s intern programwas also extended to include

prospective university graduates across a wide

rangeofbusiness relateddegreeswho requirework

experienceinordertocompletetheirdegree.During

the latter part of 2018OSTI employed two business

interns,LindokuhleNtuliandComfortMaluleke.

Customer experience departmentIn an effort to improve the overall customer

experience,reducethenumberofinternalcomplaints

and escalations and acquire a better understanding

of OSTI’s strengths and weaknesses, a dedicated

customer experience department was established

in 2018. Naturally it will take some time before the

learningsfromthisdepartmentfilterdownthroughthe

organizationandtherequiredchangestooperations

are implemented. However, in the short time since

its establishment, this department has already

provided OSTI’s management with much needed

insight intomany of the day-to-day concerns arising

from customers who make use of OSTI’s services.



SeniorAssistantOmbudsmanAyandaMazwi is tobe

commendedfortheexcellentworkthatshehasdone

inestablishingthisdepartment.

In closingI am, as ever, extremely grateful to the chairman of

OSTI’s board, Haroon Laher for the assistance and

guidance that he provided to OSTI during 2018 and

forhisunfailingsupport.Thanksalsogototheother

members of the board for their insight, rigorous

debate and commitment to the betterment ofOSTI.

I am also extremely grateful to themembers of the

auditcommittee for theadviceandservice that they

providetoOSTI.

Finally,mysincereappreciationandthanksgotomy

managementteamandseniorassistantombudsmen

who have worked tirelessly to make the transitions

possible. OSTI achievements in 2018 would not

have been possiblewere it not for their careful and

measured advice and assistance in every decision-

making process. As always, special mention must

bemade ofmyDeputyOmbudsman, Edite Teixiera-

Mckinon for her unwavering support, wise counsel

andongoingwillingnesstoembracechange.

This year’s annual review reflects many aspects of

whichOSTIcanbeproud. InreflectingontheseIam

gratefultoourpeopleforalltheirresilience,hardwork

andcommitmenttoOSTI.Wewillcontinuetoimprove

our business and to strive to provide the service that

isexpectedofus.

Deanne WoodOmbudsman for Short Term Insurance

April 2019

REPORT BY THE OMBUDSMAN 11


In last year’s Annual Report, the Ombudsman,

Deanne Wood, touched on the anticipated evolution

of financial ombud schemes under the then newly

enactedFinancialSectorRegulationsAct2017(“FSRA”).

Deannemadementionedoftheconsultativeprocess

that had taken place between the four voluntary

financial ombud schemes (OSTI, the Long-Term

InsuranceOmbud,theBankingOmbudandtheCredit

Ombud) andNational Treasuryonproposals for the

futureconstructoffinancialombudschemes.

The dramatic overhaul of legislation governing the

financial environment in South Africa will naturally

haveaconsequential impacton thefinancialombud

schemes. Resistance to this change is futile and it is

important to approach these changeswith the right

mindsetbecause,afterall,“thebamboothatbendsis

strongerthattheoakthatresists.”1

AkeydriverforchangeandanareawhereOSTImust

do some bending is in relation to chapter 14 of the

FSRA.

Chapter14oftheAct,headed“OMBUDS”,isstilltocome

intoeffect,agovernmentnoticehavingbeensentout

on18March2019deferringitsimplementationdateto

1September2019.

Under this chapter, an Ombud Council will be

establishedwiththeobjectiveto“assistinensuringthat

financialcustomershaveaccessto,andareabletouse,

affordable,effective,independentandfairalternative

dispute resolution processes for complaints about

financial institutions in relation tofinancialproducts,

financial services, and services provided by market

infrastructures” (Section176).By the inclusionof the

word “services”weenvisage thatwewillberequired

toexpandour jurisdictiontodealwithpurelyservice

relatedcomplaints.CurrentlyOSTIdoesnotdealwith

serviceissuesunlesstheservicehasadirectfinancial

impactonthecomplainant.Thischangewillhavethe

effectofenlargingourjurisdictionalcoverage.

TheBoardof theOmbudCouncilwillhaveaduty to

keeptheMinisterofFinanceinformedof“trendsinthe

natureofcomplaintsandissuesraised incomplaints

thatombudschemesaredealingwith,andhowthose

typesof issuesand complaints arebeingdealtwith”

and“theconductoffinancialinstitutionsthatisgiving

risetocomplaintstoombudschemes”(Sections184(d)

(ii)and(iii)).Wewillthereforeberequiredtoreportto

theOmbudCouncilnotonlyonthetrendsemerging

from lodged complaints but also on how these

complaintswereresolved.ThismayrequirefurtherIT

enhancementstoourcurrentsystemstoenableusto

harvestmoredata.

collaboration breeds success

Edite Teixeira-McKinonDeputy Ombudsman

1 Japaneseproverb


In termsofSection188(4)(a) “theChiefOmbudmust

convenemeetingsoftheombudsonaregularbasis,

butatleastfourtimesayear,todiscusstheeffective

operation of the ombuds system.” Currently under

theFinancialServicesOmbudSchemesAct,2004,(“the

FSOSAct”)wehaveonlybeenrequiredtopresentour

annual reports to the Council established under this

Act.

The Ombud Council may impose administrative

penalties on an ombud scheme, a member of the

governing body of an ombud scheme or on an

ombud, may request information from an ombud

or ombud scheme and may conduct supervisory

on-site inspections and investigations of an ombud

scheme or ombud. The Ombud Council may make

rules, amongst others, in relation to the governance

ofombudschemes,thequalificationsandexperience

ofombuds, the typesof complaints tobedealtwith

by a specific ombud scheme and dispute resolution

processes.

Although there will be more operational oversight

by the Ombud Council of ombud schemes than

previouslyunder the FSOSAct, Section201(4) of the

FSRApreservestheindependenceofombudschemes

and ombuds when it comes to decision making on

complaints. This section reads “an Ombud Council

rulemustnot interferewith the independenceofan

ombud or the investigation or determination of a

specificcomplaint.”

Ifthereisnorecognizedindustryorstatutoryombud

scheme to deal with a particular kind of financial

productorservice,thentheOmbudCouncilmay,after

consulting the relevant ombud schemes, designate

one or more ombud schemes to deal with and resolve

complaints arising from such product or service

(Section211).Againourjurisdictionmaybeexpanded

bytheOmbudCouncil.

Collaboration between ombuds and ombud schemes

is encouraged in Section 213 which includes

“developingprocessesandprocedurestojointlyhear

and determine complaints, on their own initiative or as

mayberequiredbyOmbudCouncilrules.”

This encouraged collaboration from the legislature

bringsmetothenextaspectofbamboobendingthat

OSTImustface.Againstthebackdropofchangesinthe

policyenvironmentandthecallbyNationalTreasury

forself-determinedrationalizationofportsofentryfor

consumers into these schemes, OSTI initiated an in-

principleagreementwiththeOfficeoftheLong-Term

Insurance Ombudsman (“OLTI”) to amalgamate the

twoschemesintoasingleinsuranceombudscheme.

The process of amalgamatingwithOLTI is still in an

exploratory stage with key decisions to be taken

during the course of 2019. The build-up to these

decisionsbeing takenpresents the idealopportunity

toexploretherationalebehindthisdecisionandtoask

the importantquestions about thenecessity for this

change–afterall,ifitain’tbroke,whyfixit?

Insurance products and the accompanying services

that theyprovideno longer fallneatly intoexpressly

categorized divisions between long and short term

insurance. This bundling together has also been

recognizedby the legislature through theenactment

REPORT BY THE DEPUTY OMBUDSMAN 13


of a single piece of legislation (the Insurance Act 18

of2017)governingallaspectsofinsuranceregulation

underasinglestatute.

Increasing levels of awareness, although still low,

have resulted in increasing customer demand and

expectations when it comes to dispute resolution

by ombud schemes. There are greater expectations

of speed, simplicity and online assistance. These

expectations enhance the need to ensure that the

handlingofinsurancecomplaintsisequallyintegrated.

In OSTI’s and OLTI’s environments this would mean

concurrentlyhandlinganyshort-terminsurance(now

referred to as “non-life” insurance in the Insurance

Act) aspects of a complaint together with any long-

termorlifeinsuranceaspectsofthesamecomplaint.

An integratedofficewillmeanthat thetimetakento

resolve the entire complaint will be reduced and the

consumerneednotsufferanyconfusionaboutwhich

ofthetwoofficestoapproach.

An amalgamation will focuses on creating a

single port of entry into and exit from an ombud

schemewhilst ensuring a seamless experience for

complainants of both life and non-life insurance.

In considering this “single shop front”, we have

had to re-evaluate our processes and procedures

and compare themwith those of OLTI in order to

decidewhichprocesswillworkbest.Asa resultof

this re-evaluation,OSTI has already remodelled its

complaintshandlingprocessesby:

1) enablingcomplainantstolodgecomplaintson-line

andtelephonically,

2) enabling the faster resolutionof complaints that

arecapableofearlyinitialassessment,

3) enabling and incentivising insurers to resolve

complaints at complaint inception, and

4) enablingmorecomplaintstoberesolvedthrougha

facilitativeprocess,beingnegotiation,conciliation

andmediation.

George Bernard Shaw wrote: “Don’t wait for the

right opportunity, create it.” The exploration of an

amalgamationwithanotherombudschemehasgiven

OSTItheopportunitytorelookattheway inwhich it

operatesandtocreatetheopportunitytoimproveits

serviceoffering.

Ombud schemes in other jurisdictions around the

world have undergone major reconstruction and

amalgamatedtoformonescheme,suchastheFinancial

OmbudsmanServiceof theUnitedKingdomand the

Australian Financial Complaints Authority. Although

our ombud scheme for all financial complaints, it is

almost inevitable that this is the direction that we are

movingin.

ConclusionCharles Darwin said “it is not the strongest of the

speciesthatsurvive,northemost intelligent,butthe

onemostresponsivetochange.”

Change isn’t inherently good or bad; it is something

that is inevitable and something without which

progressisimpossible.Theonlywaytoparticipatein

aconstantlychangingworldistofindwaystoconnect.

Thelesswechange,themoresiloedwebecome.Inthe

lastyear,morethanever,OSTIhashadanopportunity

to see different perspectives, get different points of

view and come up with new ideas and approaches that

willhelp ittobecomeevenmoreeffective inaworld

thatcontinuestochange.

Edite Teixeira-MckinonDeputy Ombudsman

REPORT BY THE DEPUTY OMBUDSMAN 15


Miriam MatabaneGeneral Manager

finance matters

2018 Annual Financial Statements

PricewaterhouseCoopers Inc. audited the annual

financialstatementsfortheyearended31December

2018. The financial statements were prepared in

accordance with International Financial Reporting

StandardsandtherequirementsoftheCompaniesAct

ofSouthAfrica.

During2018financialyear,OSTIchangeditsaccounting

policy for the recognition of revenue. The revised

revenuerecognitionresultedinanadjustmentofthe

retainedincomeanddeferredincomefigures.

The annual financial statements present fairly, in all

materialrespects,thefinancialpositionofOSTI.Weare

proudof the fact thatwehaveconsistentlyachieved

cleanauditreportsovertheyears.Thesecleanaudit

reportsprovideasolidfinancialreportingbase.

The approved and detailed audited financial

statements are available on our website: www.osti.co.za

Acopyofour2018AnnualFinancialStatementswillbe

emailedtoallourmembers.

FINANCE MATTERS 17

Financial PositionOSTI remains financially sound with all member

insurerssettlingtheiroutstandingdebtsinfullforthe

financialyearended31December2018.

TherevenueofOSTIdependssolelyonfeesleviedto

member insurers against new complaints received.

Wearepleasedtonotethatdespitedifficultfinancial

conditions,memberscontinuetosupporttheoffice.

OSTI recorded an increase of 9% in the number of

complaintsreceivedforthe2018financialyear.

OSTI’s revenue for the year was R38.1 million, an

increase of 12% compared to 2017 (R33.9 million).

This increase is primarily attributable to the annual

fee increase which, in 2018, went from R3 700 per

complainttoR4000.

OSTIcontinuestomanageitscashbalancescloselyto

ensure that there is sufficient cash tomeetfinancial

obligationswhentheyfalldue.

Liquidation of saXum Insurance companySaXum Insurance remains in liquidation.OSTIawaits

the outcome of the claim it has submitted to the

liquidator.

Board, Audit and Risk CommitteeThe Board and Audit Committee approves the

financial reports and reviews strategic, operational

andcompliancerisksquarterly.Theirroleistoensure

that risk management frameworks, methodologies

and mitigations are implemented effectively. OSTI’s

finance department thanks thesemembers for their

invaluablesupportandguidance.

New MembershipNoapplicationsformembershipwerereceivedduring

2018.Thelistofmembercompaniesisenclosedinthis

report.

Miriam MatabaneGeneral Manager


office statistics

Formal complaints closed

Rand value of complaints resolved in favour of insured - Claim type

9 9448 6319 9629 474

2015

2016

2017

2018

60 000 000

56 000 000

52 000 000

48 000 000

44 000 000

40 000 000

36 000 000

32 000 000

28 000 000

24 000 000

20 000 000

16 000 000

12 000 000

8 000 000

4 000 000

0

Commercial Home Owner Household Motor Other Non-Claim Related

R3 8

29 7

15

R136

319

2018R87 250 982

R13

987

137

R12

369

548

R3 2

88 6

05

R53

641

058

R5 3

15 6

95

2017R87 101 353

R19

982

717

R11

829

111

R4 2

80 9

12

R45

692

919

R7 3

39 0

30

2016R99 139 593

R16

029

454

R10

159

765

R59

238

533

R6 3

72 8

11

2015R100 712 182

R18

513

071

R15

498

565

R7 3

39 7

24

R52

897

530

R6 4

63 2

92

Finalisation per period

Total cases closed: 100%

65% 20% 15%

Finalised within 4 months

Finalised between 4 and 6 months

Finalised in over 6 months


Claim types resolved ratio - 2018

Types of complaints by cases (on matters received for 2018)

Formal Complaints Received

MiscellaneousTotalClosed:1490Resolved:436Ratio:29,26%

Home Owner TotalClosed:2037Resolved:254Ratio:12,47%

Commercial TotalClosed:909Resolved:147Ratio:16,17%

MotorTotalClosed:4510Resolved:824Ratio:18,27%

Non-claimRelatedPolicy 129 Household Contents 529 Commercial 895Other 1 473Home Owners 2 037Motor 4 716

Household ContentsTotal Closed: 528Resolved:77Ratio:14,58%

9,2%5,4%

1,3%

48,2%

15,1%

20,8%

2015

Total Complaints Received2016 2017 2018

4 352

9 784

4 741

10 175

5 079

9 097 9 779

14 136 14 916 14 176 13 805

Preliminary Matter Received

4 026


Ayanda MazwiSenior Assistant Ombudsman

a statistical analysis of matters closed by OSTI in 2018

During2018,OSTIfinalizedatotalof

9 474 formal complaints

This was 97% of the total number of complaints

registeredinthesameperiod.

OSTI classifies complaints according to the type of

insurancepolicy the consumer complains about, the

issuesinvolvedandtheoutcomeofthedispute.

Highest categories of complaints received:

The remaining 17% of complaints related to other

insuranceproductsincludingpersonalaccident,water

loss, travel, all risk, mobile device, legal expenses,

hospitalcoverandgapmedicalcover.

In more than two thirds of finalized complaints,

consumers complained about the insurer’s decision

onaclaim.Overall, themajorityofthesecomplaints,

at36%,relatedtotherejectionofaclaimonthebasis

of an exclusion or warranty in the policy terms and

conditions. This figure remained virtually unchanged

whencomparedto2017.ItiscleartoOSTIthatmany

consumersdonotknoworunderstandwhatisintheir

policy documents. Because it is not possible to go

throughallofthetermsandconditionsofcoveratsales

stage, insurers are required to provide the insured

withpolicydocumentsdraftedinsimplelanguage.The

insured must read these documents and consult the

insurerorbroker should therebeaneed for clarity.

Ifadisputerelatestowhattheinsuredwastoldwhen

the policy was being sold, OSTI considers all sales

communications,writtenandverbal.

The remainder of finalized complaints related to

complaints about non- claim related policy disputes,

such as policy changes, cancellations or lapsing,

premiumincreasesandservicerelatedcomplaints.

Motor vehicle insurance at 48% ofthetotalnumberof finalizedcomplaints.

Followedby homeowners insurance at 21%.

Complaintsrelatingtocommercial insurance increased from8%in2017to 9% in 2018.

Household content insurance complaints decreased from6%in2017to5% in 2018.


“So what, in relation to these categories, did people complain about the most?”Motor vehicle insurance dipsutes ThemajorityofcomplaintsconsideredbyOSTI,at74%,

wereforaccidentaldamage.Thiswasalsothecasein

2017. Warranty and mechanical breakdown claims

comprised9%.Theftandhijackclaimscomprised8%,

aslightdecreasefrom9%in2017.

The primary cause for complaintswas theamount offered for the settlement of claims. The disputes

varied from thecalculationof vehicleand/or salvage

values, uninsured credit short-falls and accessories,

excessesandtheuseofalternateorsecondhandpart

pricesincalculatingtherepairamount,tonameafew.

The secondary cause for complaints was rejections

based on the insured’s alleged non-disclosure or misrepresentation of underwriting details at sales stage. However, OSTI saw a 22% decrease ofsuchcomplaintsin2018comparedto2017.OSTIhas

always emphasized the importance of the insured’s

contractual obligation to provide true and complete

information when taking up a policy or updating it.

Insurersarealsorequiredtoconductthesalesprocess

inaccordancewiththeagreedindustrycode.

OSTI also recorded a 15% decrease in the number of considered complaints relating to rejections onthe grounds that the insured was driving under the influence of alcohol (dui). We believe this

declinecanbeattributedtoseveralfactors,including

increasedconsumerawarenessandresponsibilityon

thedangersandconsequencesofdui,measurestaken

bytheinsuranceindustry(suchasthe‘takemehome’

service) and, the strong approach taken by OSTI on

theinsurer’sevidentiaryburdenwhendefendingthis

rejection.DUIstillremainsaveryrealproblemforthe

insurance industry and wemust caution consumers

that a rejection may be justified on circumstantial

evidence,despitethedrivernothavingbeentestedfor

alcoholconsumptionbywayofabreathalyzerorblood

testorhavingbeenconvictedofacriminaloffencein

relationtotheincident.

Thenumberofcomplaintsrelatedtorejectionsbased

on thepolicyholder’s obligation to exercisedue care

and prevent loss increased substantially in 2018, by

48%,whencomparedto2017.

18% of motor vehicle insurance disputes were

resolved in favor of the insured, with a recovery of

R53 641 058,00wherethedisputerelatedtoaclaim.

Homeowners insurance disputesLastyear, 61% of complaints consideredbyOSTIunder



homeowner’s insurancerelatedtoclaimsfordamage caused by acts of nature. Theseclaimsrelateprimarily

tostormrelated loss. In2018, thisfiguredropped to 58%. Theft and burglary claims on the other hand

increasedfrom4%in2017to6% in 2018.

The primary cause for complaint, at 48%, was the

rejectionofclaimsonthebasis of the condition of the property, this being wear and tear, lackof maintenance, defective design, construction,

workmanship and building material. This was also

the case in 2017. This rejection reason causes

consumers a lot of unhappiness, however it is the

insured’scontractualresponsibilitytoensurethatthe

building structure is properly maintained and is in

compliancewithapplicablebuildingregulations.Ifthe

damage claimed for is attributed to the conditionof

theproperty, thepolicymaynot respond even if an

insuredeventdidoccur.

The secondary cause for complaint related to

settlement calculations. Underinsurance is a real

concern.Thisiswhenthesuminsuredislessthanthe

property replacementvalue. In this case, the insurer

will only settle proportionately and the insured will

beresponsibleforthedifference.Forexample-Ifthe

sum insured isR400000and the replacement value

isR500000,only80%ofthelosswillbepaidout.This

canbedevastatingtotheinsured,particularlyduring

these soft economic times. Themainmisconception

is the insured’s belief that the municipal value,

purchase price or bond amount is the correct value,

without taking into account inflating building costs,

renovationsandreinstatementsuchasprofessional

fees, demolition and debris removal which can add

up to 20% of building costs. It may be necessary

for the insured to seek professional advice on the

replacementvalue-afterall,formanyofusourhomes

areourbiggestassets.

12% of homeowner’s insurance disputes were


R12 369 548,00 wherethedisputerelatedtoaclaim.

Household content insurance disputesTheft and burglary claims comprised 71% of complaints consideredbyOSTIunder this category.8% related to acts of nature, 6% to accidental damage and only 3% to damage caused by power surge.

As in2017, settlementcalculationswere theprimary

cause for complaints. Although rejections based on

the insured’s alleged fraudulent act, dishonesty or


OSTI ANNUAL REPORT 2018 23 OSTI ANNUAL REPORT 2018 23

misrepresentationonaclaimwasthesecondhighest

causeforcomplaints,ourrecordsindicatedanoticeable

31%decreaseinthesecomplaintscomparedto2017.

15% of household content insurance disputes were


R3 288 605,00wherethedisputerelatedtoaclaim.

Commercial insurance disputesThe majority of complaints considered by OSTIrelated to motor vehicle (29%)andbuilding claims (30%).Overall, the primary cause for the complaints

was settlement calculations and rejections on the

groundthatconditionsofcoverwerenotmet.Thelatter

includes issues such as motor vehicle roadworthiness,

commercial driver’s licenses, building security

measures and fire safety. Insurers may conduct a

professional risk survey during the underwriting

process and, based on the findings, either endorse

limitationsorstrictconditionsofcover,withwhichthe

insurediscontractuallyobligedtocomply.

16% of commercial insurance disputes were resolved

infavoroftheinsured,witharecoveryofR13 987 137,00

wherethedisputerelatedtoaclaim.

OSTIevaluates itsserviceandqualityacrossabroad

rangeofissuesweseeascriticaltooursuccess.

Based on OSTI’s overall performance, from its

Contact Center to complaints submission and

handling, 60% of complainants who completed

our customer experience surveys indicated that

they were satisfied with our service, process and

communications.OSTImustworkhardtoimprovethis

rating.Thisimprovementalsocomesfromenhancing

consumersunderstandingofOSTI’sprocessesandthe

expectationsthattheyhaveofourservice.

Everyservicecomplainthelpsusunderstandwherewe

needtoimprove.Resolvingdisputesintheshortesttime

possible was a common issue raised by consumers.

The average time to resolve disputes in 2018 was 104 days.In2017,itwas131days.Theofficetargetis100

days.However, speed isonlypartof thepicture. It is

essential that consumers feel theyhavebeen treated

fairly,whatevertheconclusionreachedonthedispute.

Strengthening internal controls and improving

efficiencywasakeyobjectiveofournewcomplaints

handlingprocessintroducedon3January2019.

Ayanda MazwiSenior Assistant Ombudsman


Explanatory notes1. Thedatamustbeunderstoodinthecorrectcontext

anditisthereforenecessarytorecordsomewords

ofexplanationinrelationtothesestatistics.

Ombudsman’s limited jurisdiction2. TheofficeoftheOmbudsmanhaslimitedjurisdiction

over commercial lines policies and, in any event,

hasjurisdictionforpersonallinesbusinessonlyup

toR3.5million,saveforhomeownersclaimswhere

thejurisdictional limit isR6.5million.Thestatistics

therefore focus only on personal lines claims

(statisticsprovidedbytheFinancialSectorConduct

Authority) and personal lines complaints received

by thisoffice. Commercial linescomplaintswhich

are not reflected in the statistics, represent only

about9.0%ofthetotalcomplaintstotheofficeof

theOmbudsman.

3.Noadverse conclusions shouldbedrawnagainst

any insurer based purely on the number of

complaints against them received by this office.

Larger insurers issue proportionately more

policieswhichcannotformthebasisofacomplaint

tothisofficeduetoourjurisdictionallimits.Thus,

for example, when considering the percentage

of complaints received by this office against a

largeinsurer,thelargeinsurer,uponasuperficial

analysis, therefore appears to attract a relatively

low number of complaints. What is the more

important statistic is the proportion of personal

linescomplaintsrelativetoaninsurer’sshareofthe

total personal lines claims reported to the FSCA.

Theclearestindicatorofthisiscolumn5,beingthe

numberofcomplaintstothisofficeperthousand

claims received by an insurer. Where an insurer

receivesahighnumberofcomplaintstothisoffice

per thousand claims, this may be an indicator

thatclaimsaredealtwithunfairlyby the insurer.

However, this statistic should be considered

in conjunction with columns 8 and 9, being the

share of matters resolved through conciliation/

enforcementbyparties/OSTI. Theoverturn rate is

explanatory notes and insurer statistics

EXPLANATORY NOTES AND INSURER STATISTICS 25

an indication that the decision of the insurerwas

changed in some respectby thisofficewithsome

additionalbenefittotheinsured.Furthercomments

ontheoverturnrateappearbelow.

4. Please note that a claim can be received by an

insurer in year one and a complaint in respect of

thatclaimmaybereceivedbyOSTIonlyinyeartwo

– hence the number in column 1may be greater

thanthenumberincolumn3.Thestatisticsrecord

the numbers received by insurers and the OSTI

respectivelyduring2018.

5. Alsonotethatundercolumn1,certaininsurersare

shownbytheFSCAstatisticsashavingreceivedno

claimsduring2018.Thismaybeexplainedon the

basisofeitherthecompanyissuingonlycommercial

linespoliciesorthatthecompanyisdormant.We

repeatthatonlypersonallinesstatisticsareincluded

inthetableasthisiswhathasbeenreceivedfrom

theFSCA(columns1and2)

Overturn rate6. The overturn rate per insurer as shown in the

table is for personal lines claims only. It excludes

commercial lines claims. If a high overturn rate

is registered, this may, but does not necessarily,

indicatethattheinsurerisnottreatingitscustomers

as fairly as it should. However the overturn rate

should be treated with considerable caution as

a high overturn rate can also be indicative of a

highdegreeofco-operationbeingreceivedbythe

Ombudsman’s office from a particular insurer in

resolving a complaint to the satisfaction of the

customer.TheOmbudsmantakesintoaccountthe

following two circumstances in determining the

Overturn Rate:

a) The decision of the insurer is overturned by

theOmbudsmanbywayofarecommendation

whichisacceptedorbywayofaFinalRuling.

b) Aresolutionof thedisputehasbeenmediated

by theOmbudsmanwith the insured receiving

abenefitwhichhe/shewouldnothavereceived

withouttheinvolvementoftheOmbudsman.

General7. Anymedia queries in relation to insurer statistics

shouldbedirectedtotheparticularinsurer.


1 2 3 4 5 6 7 8 9

Name of Insurer*

Claimsreceived

by

Insurers(FSC

Astatistics)

Shareofclaim

sreceived

byth

epa

rticularinsurer

(FSC

Astatistics)

Com

plai

nts

rece

ived

byOSTI

Shareofth

etotal

numbe

rofcom

plaints

received

byOSTI

Num

berofCom

plaints

received

byOSTIp

er

thou

sand

Cla

ims

received

byInsurer

Complaintsfin

alised

byOSTI

Complaintsfin

alised

with

som

ebe

nefitto

th

e in

sure

d

Shareofm

atters

resolved

throug

hconciliationbypartie

s

Shareofm

atters

resolved

throug

hen

forcem

entb

yOSTI

Abacus 3530 0,10% 4 0,05% 1,133/1000 2 1 50,00% 0,00%

Absa 134943 3,84% 799 9,02% 5,921/1000 803 146 14,57% 3,61%

AIG Insurance 15413 0,44% 47 0,53% 3,049/1000 54 19 29,63% 5,56%

Alexander Forbes 52817 1,50% 131 1,48% 2,480/1000 116 17 9,48% 5,17%

Allianz 453 0,01% 2 0,02% 4,415/1000 2 2 100,00% 0,00%

Auto & General 195769 5,57% 343 3,87% 1,752/1000 313 41 9,27% 3,83%

Bidvest 19459 0,55% 56 0,63% 2,878/1000 45 8 13,33% 4,44%

Bryte 131090 3,73% 140 1,58% 1,068/1000 140 32 20,00% 2,86%

Budget 79889 2,27% 323 3,65% 4,043/1000 281 31 7,47% 3,56%

Centriq 35082 1,00% 146 1,65% 4,162/1000 138 40 24,64% 4,35%

Chubb 1486 0,04% 7 0,08% 4,711/1000 7 1 14,29% 0,00%

Compass 43403 1,24% 57 0,64% 1,313/1000 43 6 9,30% 4,65%

Constantia 129670 3,69% 147 1,66% 1,134/1000 167 49 18,56% 10,78%

Dial Direct 35394 1,01% 117 1,32% 3,306/1000 106 10 6,60% 2,83%

Discovery 184994 5,26% 328 3,70% 1,773/1000 321 46 12,15% 2,18%

FirstforWomen 45135 1,28% 128 1,45% 2,836/1000 121 18 9,92% 4,96%

Genric 57284 1,63% 60 0,68% 1,047/1000 63 17 19,05% 7,94%

Guardrisk 244862 6,97% 526 5,94% 2,148/1000 494 158 27,53% 4,45%

Hollard 285819 8,13% 535 6,04% 1,872/1000 529 128 20,42% 3,78%

Indequity 2531 0,07% 4 0,05% 1,580/1000 3 1 33,33% 0,00%

Infiniti 28876 0,82% 62 0,70% 2,147/1000 67 9 10,45% 2,99%

KingPrice 81146 2,31% 428 4,83% 5,274/1000 372 64 15,32% 1,88%

LEZA 28271 0,80% 88 0,99% 3,113/1000 74 11 12,16% 2,70%

LionofAfrica$ 746 0,02% 81 0,91% 108,579/1000 37 25 62,16% 5,41%

Lloyd’s 175 0,00% 3 0,03% 17,143/1000 0 0 0,00% 0,00%

Lombard 15070 0,43% 26 0,29% 1,725/1000 16 5 18,75% 12,50%

MiWay 100 081 2,85% 484 5,46% 4,836/1000 476 52 8,19% 2,73%

Momentum ST 37757 1,07% 100 1,13% 2,649/1000 113 5 4,42% 0,00%

Monarch 20036 0,57% 4 0,05% 0,200/1000 5 3 60,00% 0,00%

insurer statistics

1 2 3 4 5 6 7 8 9

Name of Insurer*

Claimsreceived

by

Insurers(FSC

Astatistics)

Share ofclaim

sreceived

byth

epa

rticularinsurer

(FSC

Astatistics)

Com

plai

nts

rece

ived

byOSTI

Shareofth

etotal

numbe

rofcom

plaints

received

byOSTI

Num

berofCom

plaints

received

byOSTIp

er

thou

sand

Cla

ims

received

byInsurer

Complaints fin

alised

byOSTI

Complaintsfin

alised

with

som

ebe

nefitto

th

e in

sure

d

Shareofm

atters

resolved

throug

hconciliationbypartie

s

Shareofm

atters

resolved

throug

hen

forcem

entb

yOSTI

Nedgroup 67045 1,91% 300 3,39% 4,475/1000 281 65 21,35% 1,78%

New National 21529 0,61% 250 2,82% 11,612/1000 298 80 23,49% 3,36%

NMS 93772 2,67% 7 0,08% 0,075/1000 6 6 100,00% 0,00%

Oakhurst 51372 1,46% 293 3,31% 5,703/1000 266 39 11,28% 3,38%

Old Mutual 174640 4,97% 636 7,18% 3,642/1000 606 113 16,17% 2,48%

OUTsurance 268401 7,64% 345 3,90% 1,285/1000 373 21 4,56% 1,07%

PPS 6006 0,17% 5 0,06% 0,833/1000 5 2 40,00% 0,00%

Regent% (now Hollard Specialist Ins.) 46969 1,34% 110 1,24% 2,342/1000 105 26 22,86% 1,90%

Renasa 78110 2,22% 111 1,25% 1,421/1000 88 24 23,86% 3,41%

SAFIRE 7428 0,21% 10 0,11% 1,346/1000 9 0 0,00% 0,00%

SAHL 25715 0,73% 95 1,07% 3,694/1000 94 9 9,57% 0,00%

Santam Ltd 369098 10,50% 548 6,19% 1,485/1000 541 92 14,97% 2,03%

Santam Structured 41599 1,18% 233 2,63% 5,601/1000 228 24 7,89% 2,63%

SASRIA 1298 0,04% 5 0,06% 3,852/1000 4 2 50,00% 0,00%

Shoprite 2892 0,08% 10 0,11% 3,458/1000 12 6 41,67% 8,33%

Standard 115536 3,29% 549 6,20% 4,752/1000 546 77 11,54% 2,56%

Unitrans 3618 0,10% 3 0,03% 0,829/1000 4 0 0,00% 0,00%

Vodacom 96000 2,73% 45 0,51% 0,469/1000 36 21 52,78% 5,56%

Western National 23796 0,68% 108 1,22% 4,539/1000 138 33 13,77% 10,14%

Workerslife 7900 0,22% 18 0,20% 2,278/1000 10 4 30,00% 10,00%

TOTAL 3 513 905 100,000% 8 857 100% 2,52/1000 8 558 1 589 15,31% 3,27%

Please Note:TheStatisticsforABSAInsuranceCoLtdincludestatisticsforABSAIdirectandABSAInsuranceRiskManagementServicesLimited.TheStatisticsforOldMutualInsureincludestatisticsforIwyzeandMutual&FederalRiskFinancing.*Forthefullnameofthe insurerpleaseseethe listofmembersatpage42.

EXPLANATORY NOTES AND INSURER STATISTICS 27

FSCA Legend $Run-off#Deregistered%Insurerchangednameduringthe2018period


Theearlybirdcatchestheworm.SimilarexpressionsexistinvariousSouthAfricanlanguages.Ka Setswana le Sesotho sa Lebowa gothwe, “Tloga tloga e tloga kgale modiša wa kgomo o tšwa nayo šakeng.” NgesiZulu nangesiXhosa kuthwa, “Ligotywa lisemanzi.” In Afrikaans, “Die môrestond het goud in die mond.”

Theaboveexpressionssimplymeanthatitisbettertoactsoonerratherthanlater.Delayedactionmayresultinunsatisfactoryresults.

In the context of insurance claims, it often happensthatinsuredsdelayclaimingorcontestingtheoutcomeofclaimswithwhichtheydonotagree.

Mostpoliciesrequirethataclaimshouldbemadewithina specified period after the happening of an insuredevent. Failure to do so may result in claim benefitsbeingforfeited.Anexpeditiousclaimorcontestationismainlytoensurethattheclaimvalidationprocesscanbeconductedwhilefactsarefairlyeasilyascertainableandmemoriesarestill fresh;witnessesare likelystill inthevicinityofthesceneoftheincident;videofootagemightstillbeavailable;andmostoftheevidencestillintact.

Unfortunately, when insured persons delay withoutgood reasons for doing so they compromise theirprospectofclaimingsuccessfully.Sometimestheyalsodelay inchallengingdecisionstakenbytheir insurersregardingtheirclaims.Thisisveryill-advisedasmostpolicies contain a clause limiting the timeperiod forinsuredstotakeactionagainsttheirinsurer.Sometimesthishappensevenwheretheinsuredmighthavebeenabletosucceedonthemeritsofthedispute.

The Policyholder Protection Rules promulgated intermsoftheInsuranceActasrevisedprovidethattheinsurermustallow90dayswithinwhich the insuredmay follow the insurer’s internal dispute processto have a dispute resolved. In addition, there is afurther180daysforother(further)actiontobetaken,

includingapproachingtheOmbudsmanforassistanceinhavingthedisputeresolved.

Insurers who are members of the OmbudsmanschemehaveagreedthatwhereadisputeisreferredtotheOmbudsman,theapplicationofanytime-barringand prescription periods will be suspended until the Ombudsmanhasresolvedthematter.

Inthelightoftheprovisionsmentionedabove,insurersdo sometimes rely on the time bar provisions andprescription to avoid the Ombudsman consideringdisputes referred to this office. Where the insuredcannot show good cause why there was a delay inpursuing a matter through the Ombudsman’s office,theOmbudsmanmayfindthatthematterhasbecometimebarred.ThismeansthateveniftheOmbudsmanhasadimviewofhowtheinsurerhandledaparticularmatter, theOmbudsmanmaynotbe in aposition toassistthatinsuredduetoalackofjurisdiction.

In a recent matter the Ombudsman had to grapplewith the question whether or not a complaint hadbecometime-barred.

Inthismatter,theinsurerarguedanddetailedreasonswhythematterwastime-barred,submittingthattheOmbudsmanshouldnotconsiderthedisputeforthisreason.

The insurer further argued that no good cause hadbeenshownto justifythe insured’sfailureto lodgeacomplaint timeously with the Ombudsman’s officeandaccordinglytherewasnobasisforcondonationtobegranted.TheinsurerarguedthattheOmbudsmancouldnotdealwith thedispute as it fell outside theOmbudsman’sjurisdiction.

Theessentialfactswerethattheinsuredhadsuffereda losson31July2015andregisteredaclaimwiththeinsurer. The insurer declined this claim in writing

Peter NkhunaSenior Assistant Ombudsman

time bar


on 27 November 2015. Following the insured’srepresentations,theinsurermaintaineditsrejectionoftheclaim.Theinsured’slegalrepresentativerequestedadditional information from the insurer and thensubsequently made additional representations. Theinsureragaindeclinedtheclaimon13September2016.

When the insured later (in July 2017) submitted acomplaint toOSTI, the insurer raised time-barring as adefence.Accordingtotheinsurer,thematterhadbecometimebarredandtheOmbudsmandidnotthereforehavethejurisdictiontodealwiththematter.

The insurer submitted that theoriginal decisionwasmadeon27November2015.Havingonlyapproachedthe Ombudsman in July 2017, whereas the policyprovided for a twelve months’ time bar period, theinsuredhadapproachedtheOmbudsmantoolate.

It was the insurer’s contention that although theinsured’squeriesand requests for re-evaluationwereentertained, and a last communication in this regardwassenttotheinsuredon13September2016,thiswasnotinanywayawaiverbytheinsurerofitsrighttorelyontime-barringasfromthedatethatthefirstrejectionwassenttotheinsured(i.e.27November2015).

Theinsured’sargumentwasthattherelevantdateforconsidering whether or not thematter had becometime-barredbythetimetheinsuredapproachedtheOmbudsman’soffice,was13September2016.

According to the insured, this was the actual dateon which the final decision to reject the claim waseventuallytakenbytheinsurer.

It was the Ombudsman’s view that the insurer’s submission that 27 November 2015 was the date onwhich the claimwas (finally) rejected,presenteda fewproblemswhichwouldmakethatpropositionuntenable.

The first was that the insurer’s rejection letter (of 27November2015)providedthattheinsuredmaymakefurtherrepresentationstotheinsurerandalsothattheinsuredmayapproachtheOmbudsmanwithinaspecifiedperiod.

TheOmbudsman‘sviewwasthatitwasenvisagedthatsuchaprovisionwouldentailthatarealopportunitywasgrantedto the insuredtomakesuchrepresentations,and that the insurerwould be diligent in consideringthematter afresh. To have a different understandingwouldrendertheinternalreviewprocessredundant.Itwould be unreasonable to provide that there should be aprocessavailablefortheinsuredtofollow,whensuch

aprocessmeantthattheoriginaldecisionremainedinplaceandnoprospectofanewdecisionexisted.

From the circumstances and facts specific to thismatter, this position would be even more untenable as the insured’s legal representatives had requestedfurther details from the insurer prior to makingrepresentations.Thisthereforemeantthattheinsurermusthavedealtwithnewinformation,argumentsorsubmissionswhenre-consideringthematter.Thisalsoimpliedthat,althoughtheoutcomeofthematterwasnot different from the insurer’s initial stance, a newdecisionwasmadebytheinsurer,havingconsideredthe representations and any new information orargumentsmadebytheinsuredoronitsbehalf.

Theinsuredhadmerelyexhaustedtheinternaldisputeresolution mechanisms like it was invited to do, andasitwasentitledtodo.Theoptiontodothiscouldnotpossibly have been envisaged to entail self- prejudiceto the insured whenmaking use of same. It was theOmbudsman’sviewthatitwouldbeillogicaltoinsistthatthedecisionof27November2015wasnotovertakenbyevents,includingtheinternaldisputeresolutionprocess.

It was therefore the Ombudsman’s view that 13September2016wouldbetherelevantdatefromwhichtime-barringwouldcommencerunning,beingthedateonwhichtheinsurer’sfinaldecisionwastaken.

In terms of the policy and the rejection letter, theinsured had twelve months within which to takefurtherstepsaftertherejection.

From the time when the claim was rejected to when the insuredapproachedtheOmbudsman,onlytenmonthshadelapsed.Thematterwasthereforenottime-barred.

Thesecondargumentbytheinsurerthattheinsuredhadnotshownreasonablecauseforthedelaysin lodging a complaint or shown good cause whycondonation should apply became redundant byvirtueoftheaboveconclusion.

Insurers will not hesitate to use time bar provisions in their policies to avoid disputes being pursuedfurtherbyinsuredparties,wheresamemayapply.Itisthereforeadvisablethataninsuredpersontakestepstoregisteraclaimortocontestanydecisionassoonaspossibleaftertheoccurrenceofan insuredevent,orthedecisionbeingtaken,lesttheyforfeittheirrightstoclaimortocontestdecisionstakenbyinsurers.

Peter NkhunaSenior Assistant Ombudsman


Insured: My house was damaged by a storm.Insurer: But you haven’t proved your case why should we pay your claim?Insured: Because I said so……..

Insurer: We cannot pay your claim because you were driving under the influence of alcohol.Insured: But you haven’t proved your case why would you not pay my claim?Insurer: Because I said so……..

InmanycasesthatcomebeforeOSTI,oneofthepartiestothedisputedoesnotprovidesubstantialoranyevidenceto prove their case. When a matter is considered byOSTI,theevidenceandsubmissionsbybothpartiesareconsidered inorder toarriveatadecision.Ourcourtshaverepeatedlysaidthathewhoallegesmustprove.

Itisoftenfoundthattheonepartyexpectsadecisionin their favour despite the fact that they have notpresentedanysubstantialevidenceorsubmissionstoprovetheircaseordisprovetheotherparty’scase.

When a matter is considered at OSTI the evidence and submissionsareweighedandconsideredonabalanceof probabilities. This is because insurance relatedmatters fallwithin theambitofcivil law (asopposedtocriminallawwherethestandardofproofisbeyondareasonabledoubt).Civillawdetermineswhichpartybears the onus (or burden of proof) in amatter. Ininsurance law the onus rests on the insured to prove thataclaimispayableorthataninsurerisliableunderthe policy. For example, when seeking payment fordamagetoahouseundersubsidencecover,aninsuredmustprovethatthecrackstothehousewerecausedby subsidence.Mere say-sowill not be enough. Theinsuredmustprovidesubstantialevidenceofthisfact.Thisevidencecanbeintheformofanexpertsuchasastructuralengineer.Oncetheinsuredhasprovidedsufficientevidencetodemonstrateitscase,theburden

will shift to the insurer to refute that evidence. Theinsurerwillequallyberequiredtoprovidesubstantialevidencetorefutetheinsured’scase.

In circumstances where there is no dispute about an ordinarily covered event, but the insurer avoidsliability because of an exclusion or exception in thepolicy, the general rule is that the onuswill lie withtheinsurertoprovethisfact.Forexample,whereaninsurerallegesthataninsuredwasdrivingundertheinfluenceofalcoholandrejectstheclaimonthatbasis,the insurer would have to prove its case by way ofsubstantialevidence.Theevidenceandsubmissionsofbothpartieswillbeconsideredandiftheinsurerfailsto provide substantial evidence, then the insurer will besaidtohavefailedtodischargeitsonusortoproveitscaseonabalanceofprobabilities.

Each party is responsible for providing the evidencetheywishtorelyontoOSTI.OSTIdoesnotandwillnotgatherevidenceonbehalfofanyofthepartiesnorliaisewithanythirdpartywhoisnotapartytothedispute.

Before approaching OSTI complainants should beawarethat theremaybeevidencefrombothpartieswhichcreateadisputeoffactorwherematerialfactscannot be established or cannot be resolved on a clear balanceofprobabilities. In such cases, our TermsofReferencestatethatOSTImaynotmakearulingbutinstead must advise the parties that the complaint is not one in which OSTI can assist and that alternate recoursemaybesortthroughthecourts.

Ultimately,adecisioncannotbemade in favourofapartywithoutthepartyprovingitscaseonabalanceof probabilities, by providing substantial evidence. Apartywhoallegesmustproveitscase. Thasnim DawoodSenior Assistant Ombudsman

Thasnim DawoodSenior Assistant Ombudsman

because i said so…


Darpana HarkisonSenior Assistant Ombudsman

osti news

“Change is the law of life and those who look only to the past or present are certain to miss the future.” - John F. Kennedy

2018 was a year of change for OSTI. Changes in

OSTI’s physical and IT environment and are just two

of the major changes experienced by OSTI’s staff and

stakeholders. Following on what was reported in our

2017 Annual report, we are pleased to announce that

we have upgraded our telephone system, internet line,

updated and upgraded our CRM system and OSTI is now

in the cloud. All these enhancements paved the way for

a paperless environment.

As a result of the above enhancements, OSTI has

already seen savings in equipment, paper and stationary

expenditure. However, the ultimate goal is increased

efficiency in the handling of complaints. The paperless

environment has allowed for automation of certain

processes in order to reduce turnaround times.

Complainants are now able to complete their application

forms online and submit supporting documentation. This

reduces the possibility of human error in data capturing

and the time taken to capture complaints manually.

With big change comes big challenges. OSTI

acknowledged the shortcomings of the new system

by hosting a workshop with insurers at the beginning

of 2019 where the new process was introduced to the

insurers. A comprehensive question and answer session

helped in identifying and resolving the challenges being

experienced by insurers. In addition, OSTI is engaging

its staff on a regular basis to receive feedback, provide

training and identify recurring issues and areas for new

development.

As we look to the future, we are enhancing and optimizing

our system to support new processes.

Darpana HarkisonSenior Assistant Ombudsman


intervening insured perils: an application of equity

Insurance is commonly referred to as a grudgepurchase. You calculate yourmonthly instalment onyournewcarandyoucanjustaffordit.Youarriveatthedealershipandyouarepresentedwithafinanceagreementthatcontainsanumberofadditionalcosts,suchasfinancecharges.Youstartsweatinganddoingquick calculations in your head. Just as you breathea sigh of reliefwhen you estimate that your budgetwill JUSTmake it,youaretoldthatyouhavetohaveinsurancebeforedrivingthevehicleoffthedealershipfloor, thus stretching your budget even further. It isnowonderthatmotoristsloathpayingapremiumforsomethingthattheymayneverevenuse.

Intruth,aninsurancepolicyisthefinancialsafetybeltor airbag for savvy consumers. Without insurance,many buyers of high value vehicles understandablywould not feel comfortable with the transaction,takingintoconsiderationtheriskofdrivingthevehicleonSouthAfricanroads.Thedevastationexperiencedbypolicyholderswhenaclaimisseeminglyarbitrarilyrejected based on an obscure technical point, is thereforeunderstandable.

This was exactly what occurred when an insuredpurchased a used high price vehicle from themanufacturingdealer.Amerecoupleofhoursaftertheinsuredcollectedthenewlypurchasedvehicle,hewasinvolvedinanaccidentandatotallossoftheexpensivevehiclewas incurred. Itwas common cause that theaccident occurred as a result of the vehicle’swheelsseparatingfromitschassis.Thisimpliedalatentdefectintheconstructionofthevehicleandthatthedamagetothevehiclewasasaresultofmechanicalfailure.

A particular exclusion applies to damage that resultsfrommechanicalfailure,whichwasevidencedtobetheproximate cause of the damage in the matter underdiscussion.ProximatecausewasdefinedinthecaseofPawseyvScottishUnion&NationalInsuranceCompany(1908) as “the active and efficient cause that sets inmotion a train of events which brings about a result,

withouttheinterventionofanyforcestartedandworkingactivelyfromanewandindependentsource”.Thiswouldbethenearestcauseandnotaremotecause.

While OSTI agreed that damages resulting frommechanical failureareexcluded fromcoverand thatmechanical failure was the proximate cause of thesomeofthedamageincurred,therewasasubsequentaccidentwhichresultedindamage.Accidentdamageisaninsuredperilintermsofthepolicy.

OSTI, in applying its equity jurisdiction, found that aclear distinction had to be drawn between damageresulting from an accident and damage resultingfrom mechanical failure. The damage resulting frommechanicalfailurewaslimitedtothewheelseparatingfromthechassis.Alldamagethatoccurredbeforetheaccidentandwhichmaybetermed“mechanicalfailure”wouldbeexcludedfromcoverintermsoftheexclusionin thepolicywording.Anydamageresulting fromtheaccidentwasaninsuredperilandhadtobesettled.

It is the view of OSTI that if a peril based policyprovidescoverforanevent,theentireclaimmaynotbeexcludedbyageneralexclusioniftheinsuredeventdidoccurcausingfurtherdamage.Theinsuredeventmust thereforebeapplied in themannerofanovusactusornewcauseofdamage.Thus,damagearisingfrommechanicalfailuremaybeexcluded,butdamagearising from an accident, which is an insured peril,mustbesettledbytheinsurer.

It was recommended that the insurer settle all accident relateddamageandexcludedamagewhichresultedfromthelatentdefect/mechanicalfailureuptothepointoftheaccident.Inthealternative,theinsurerwastosettlealldamagesandclaimbackfromthemanufacturingdealer.The insurer accepted the recommendation of theOSTIanditdecidedtosettleallaccidentrelateddamageonly.

John TheunissenAssistant Ombudsman


Mr N insured his household contents and submitted aclaimtohisinsurerfollowingaburglaryathishomein April 2018. The insurer rejected the claim and itsrejection letter noted the repudiation reason as:During the claim’s validation it was established thatMrN’slossoccurredatadifferentriskaddresstothatnotedinhispolicyschedule.MrNadvisedtheinsurerthat he had changed his address inDecember 2017buthadfailedtoinformtheinsurerofthischange.

The insurer argued that household contents cover is a“premises-based” cover and therefore Mr N was onlycoveredatthenotedriskaddress.Inthisregardtheinsurersubmitted that the household contents cover provided to MrNwasfortheriskaddressinKlipfonteinView,Midrand,whilstthelossoccurredinSagewood,Midrand.

Despite the rejection reason noted in its own rejection letter being “Material change in Risk”, the insurermaintainedthatitdidnotviewthisasachangeinrisk,butsimplyasanissueofnocover.Itarguedthattheinsured’snewaddressisacompletelynewriskwhichitneededtounderwritebeforeassessingacceptabilityandthegoverningtermsandconditionstherein.

Accordingtothepolicywording,thepolicyholderhasa responsibility to inform the insurer immediatelyof any information about the risk that has changedor that is no longer true and complete. The insurerarguedthatMrNhadadutytoinformtheinsurerofthechangeinriskaddressassoonasithappenedtoenabletheinsurertoassesstheriskanddetermineitsacceptability. The insurermaintainedthat itwasnotprovided with an opportunity to underwrite Mr N’snewaddressandassessitsacceptabilityoncover,andthereforetherecouldbenocover.

Whilst OSTI agreed that Mr N was under a duty tonotify the insurer of the change to the risk address,therewasnoevidencepresentedtosuggestthatMrNintentionallyfailedtodisclosethis informationtotheinsurerinordertopayalowerpremium.Therewasalsonoevidenceonrecordthatsuggested

thattheinsurerwouldnothaveacceptedtheriskhaditbeenadvisedofthenewaddress.Inlightofallthesubmissionsmadebythepartiestothedispute,OSTIwasoftheviewthattheinsurer’sresponsetothisofficewasdisingenuousasitsrejectionletteracknowledgedthistoindeedbeachangeinriskduetoMrN’sfailuretonotifytheinsurerthathehadchangedtheaddresswhere his contents were kept. OSTI’s view was thatessentiallytheinsuredfailedtonotifytheinsurerofachangeintherisk.

Section53oftheShort-termInsuranceActprecludesaninsurerfromdecliningaclaimasaresultofanon-disclosureorfailuretodiscloseunlesstheinsurercanestablish that it would “havematerially affected theassessmentoftheriskunderthepolicyconcernedatthetimeof its issueoratthetimeofanyrenewalorvariationthereof.”

Theinsurerhasadutytoprovethatapolicyholder’snon-disclosure is material and the insurer needs to show how ithasbeenprejudicedbythepolicyholder’sbreach.

OSTI referred the insurer to Pillay v South AfricanNational Life Assurance Co Ltd 1991 (1) SA 363 (D)wherethecourtreferredtothe“Didcottprinciple”andheldthatiftheinsurerwouldstillhaveissuedthepolicy,albeitatahigherpremium–even if the informationwithheldmateriallyaffectstheassessmentoftheriskbytheinsurer–thenitwouldnotbefairfortheinsurertorepudiatetheclaim.

Itwasaccordingly therecommendationof thisofficethat the insurer settle this claim on a proportionate basis if it could show that it suffered a premiumprejudice, alternatively, if it couldnot, then ithad tosettletheclaiminfull.

The insurer accepted our recommendation and settled MrN’sclaiminfull.

Regina ChindomuAssistant Ombudsman

no cover - material change in risk


Standing from left: Leigh Bennie, Paul Crankshaw, Farzana Badat, Viviene Pearson, Collin Molepe and Magauta Mphahlele

board of directors

Seated from left: Gerhard Genis, Richard Steyn, Haroon Laher, Thuli Zungu and Gail Walters


staff of the ombudsman

Ombudsman Deanne Wood

Deputy OmbudsmanEdite Teixeira-Mckinon

General ManagerMiriam Matabane

Senior Assistant OmbudsmanAyanda MazwiDarpana HarkisonPeter NkhunaThasnim Dawood

Assistant OmbudsmanAbri VenterHannes BesterJohan Janse van RensburgJohn TheunissenKgomotso MolepoLora BezriNadia GamieldienRegina ChindomuSangeetha SewpersadValerie Mngadi

Office ManagerAzeht Du Plessis

Assistant to the Ombudsman and Deputy OmbudsmanJanine Jacobs

Project CoordinatorMarilize Blignaut

Complaints Registration ManagerKarinien Kok

Complaints Registration AdministratorsGadija FisherMaureen NelRefilwe Mokoena

Complaints Transfer ManagerJo-Anne Goqo

Complaints Transfer AdministratorsMary TshabalalaMelissa van Zyl

Case AdministratorsAadielah SolimanClaudia KampmannJoanne SergelLouisa GodspowerMarinda NolteSelinah ZwaneVantera Freemantle

ReceptionistLebohang Morokolo

ClericalMavis MabasoSibongile Gumede

Clerical Assistant/CleanerMariam Khampepe


terms of reference

1. Preamble1.1 The Ombudsman is appointed to serve the interest

of the insuring public and all short-term Insurersregistered under the Short-term Insurance Act andincluding Lloyds. The Ombudsman provides, free ofcharge, an accessible, informal and speedy disputeresolution process to Policy Holders who havedisputeswiththeirInsurerswherethosedisputesfallwithintheOmbudsman’sjurisdiction.

1.2 TheOmbudsmanacts independentlyandobjectivelyin resolving disputes and is not under instructionsfrom anybody when exercising his or her authority.TheOmbudsmanresolvesdisputesusingthecriteriaoflaw,equityandfairness.TheseTermsofReferencedefinethepowersanddutiesoftheOmbudsman.

1.3 The services rendered by the Ombudsman are notthe same as those rendered by a professional legaladvisorandareconfinedpurelytoresolutionintermsofclause3.1belowormediationorconciliationinanattempttosettlecomplaints.

2. DefinitionsInthesetermsofreferencethefollowingexpressionshavethefollowingmeanings:2.1 “the Board” means the Board of Directors of the

OmbudsmanforShort-termInsuranceNPC;2.2 “CommercialLinesPolicy”meansapolicy(a)issuedtoa

personwhoisnotanaturalperson,or(b)ifissuedtoanaturalpersonisintendedtoindemnifysuchanaturalpersoninrespectofacommercialenterpriseconductedbythenaturalpersonforhisorherownbenefit.

2.3 “the Complainant” means any Policy Holder whomakesacomplaint to theOmbudsman inrespectofanyinsuranceservicesprovidedbytheirInsurer;

2.4 “Ruling”means,withrespecttoacomplaint,awrittendirectiveissuedbytheOmbudsmanwhichisbindingontheInsurerandwhichisbasedeitherinlaworequity;

2.5 “the Ombudsman” means the Ombudsman for Short-termInsuranceappointedfromtimetotimebytheBoardoftheOmbudsmanforShort-termInsuranceNPC;

2.6 “Ombudsman’s office” means the office of theOmbudsmanestablishedtoperformthefunctionssetoutinthesetermsofreference;

2.7 “Policy”meansashortterminsurancePolicyissuedbyanInsurertoaPolicyHolder;

2.8 “Policy Holder” means the person entitled to beprovidedwiththePolicybenefitsunderaPolicy;

2.9 “Insurer” means a short-term insurer registered assuchintermsoftheShort-termInsuranceActof1998;

The Ombudsman’s Powers and Duties3.1TheOmbudsmanshall:

3.1.1 actwithinthesetermsofreference;3.1.2 receive complaints relating to the provision

withintheRepublicofSouthAfricaofinsuranceservicesbyanInsurertoaPolicyHolder;

3.1.3 resolvesuchcomplaints,relatingtotheprovisionof insurance services, by agreement or by themaking of a ruling or by such othermeans asmayseemexpedient,subject to these termsofreference.

3.2 The Ombudsman should advise the public on theprocedureformakingacomplainttotheOmbudsman’sofficeand should take such stepsas are reasonablypossible conducive to client and industry educationand training. The Ombudsman shall in his annualreportreferredtoinclause3.9belowprovidedetailsofstepstakeninthisregard.

3.3 On receipt of a complaint in the prescribed format,the Ombudsman will notify the Insurer of thecomplaint by providing the details of the complaintto the Insurer,and the Insurershall thenbeobligedto give all relevant information and assistancerequired (includingdocumentation requestedby theOmbudsman) to enable the Ombudsman to assessfullythemeritsofthecomplaint.

3.4 DuringanyperiodinwhichtheOmbudsmanisunableto exercise his duties owing to absence, incapacityordeathorinasituationwhereaconflictof interestmayarise,theBoardmayappointadeputyoractingOmbudsmantoactinplaceoftheOmbudsman.

3.5 TheOmbudsmanshallhavetheoverallresponsibilityfortheconductofthedaytodayadministrationandbusinessoftheOmbudsman’soffice.TheOmbudsmanmay appoint an Administrator to be responsible tohim for day to daymatters of administration of theOmbudsman’soffice.

3.6 The Ombudsman shall have the power on behalfof the Ombudsman’s office to appoint and dismissemployees, consultants, legal experts, independentcontractorsandagentsandtodeterminetheirsalaries,fees,termsofemploymentorengagement.

3.7 The Ombudsman shall have the power to incurexpenditure on behalf of the Ombudsman’s officein accordance with the current financial budgetapprovedbytheBoard.

3.8 TheOmbudsmanshallgivetheBoardanyinformationandassistancewhichitreasonablyrequires,includingthemakingofrecommendationstotheBoardonanyissues which the Ombudsman believes requires theBoard’sattention.

3.9 The Ombudsman shall publish an annual report ontheactivitiesoftheoffice,whichshallbepublishedby30Mayofeachyear.Suchreportwillbeavailabletothepublic.

4. The Jurisdiction of the Ombudsman4.1 The Ombudsman shall only consider a complaint

madetohimifheissatisfiedthat:4.1.1 the complaint is not the subject of existing

litigation;4.1.2 thecomplaintisnotthesubjectofaninstruction

to an attorney in contemplation of litigationagainst the relevant Insurer except where theattorneyhassimplyassistedthePolicyHolderinbringingtheapplicationtotheOmbudsman;

4.1.3 thecomplaintdoesnotinvolveamonetaryclaimin excess of the amount determined by theBoard fromtime to timeand that in respectofCommercial Lines Policies the annual turnover oftheComplainantdoesnotexceedtheamountdeterminedbytheBoardfromtimetotime.*

*Thelimitsarecurrentlyasfollowsnamely,(a)R4million for houseowner’s claims; (b) R2million


for all other claimsprovided that (c) in respectofCommerciallinespolicies,theturnoveroftheinsuredentitymustnotexceedR25millionperannum

4.1.4 thecomplaintismadebyaPolicyHolderoradulyauthorised representative of the Policy Holdertowhomorforwhomtheinsuranceservicesinquestionwereprovided;

4.1.5 thecomplaint relates toanydispute in regard toa Policy and/or any Claim or Claims thereunderoranydispute in regard to insurancepremiums,or any dispute on the legal construction of thePolicy wording relating to a particular complaintcomplyingwiththerequirementsofthisclause4.1;

4.1.6 thecomplaintisbeingpursuedreasonablybytheComplainant and not in a frivolous, vexatious,offensive, threatening or abusive manner, asthe Ombudsmanmay decide in his or her solediscretion;

4.1.7 the complaint has not become prescribedin terms of the Prescription Act, 1969 or anyenforceable time bar provisions containedin the Policy, provided that in relation to anyenforceabletime-barprovisionsinthepolicy4.1.7.1 theOmbudsman shall have the power

to condone non-compliance therewith upongoodcauseshown,and

4.1.7.2 theprovisionsof anyenactmentwhichprovidesfortheextensionofanyperiodcontained in such time-bar provision shallbegiveneffectto.

4.2 ShouldacomplaintbelodgedwiththeOmbudsman’soffice and thereafter the Complainant refers suchdispute to an attorney for the further conduct ofthe dispute and/or direct correspondence with theInsurer, or for litigation, then the Ombudsman willimmediatelywithdrawfromthematter.

4.3 With the written consent of an Insurer and at hisdiscretion the Ombudsman may investigate acomplaintwhichexceedshis jurisdictionandmakearecommendationoraRulinginrelationthereto.

4.4 A Complainant may at any time terminate theOmbudsman’s adjudication of the complaint andresorttolitigation.

5. Limits on the Jurisdiction of the Ombudsman Subject to these terms of reference, the Ombudsman

shall have the power to consider a complaint made to him andmakearecommendationorRuling inregardtheretoexcept:5.1 Where the Ombudsman determines that it is more

appropriate that the complaint be dealt with by acourtof laworthroughanyotherdisputeresolutionprocess;

5.2Wherethematterisalreadyundertheconsiderationbythe person appointed to adjudicate disputes in terms oftheFinancialAdvisoryandIntermediaryServicesAct.

6. Time Barring Provisions6.1 AnyenforceabletimebarclausesintermsofaPolicy

6.1 Any enforceable time bar clauses in terms of aPolicy shall not runagainst aComplainant and shallbe interruptedduring theperiod that the complaintis under consideration before the Ombudsman. Inparticular, the Insurer waives and abandons all or any rights to rely in subsequent litigation on anytimebarringprovisions in thePolicy applying to thecommencementoflitigationafterrejectionofaclaim,or after the happening forming the subject of theclaim or after notification of the claim. In the event

of the complaint being finalised in the office of theOmbudsman the Complainant shall have 30 (thirty)daysortheremainingperiodofthetimebarprovisionoftherelevantpolicy,whicheveristhelonger,withinwhich to institute proceedings against the relevantInsurer, provided however, that the Claim had not already become time barred in terms of the PolicywhenthecomplaintwasreceivedbytheOmbudsmanand the Ombudsman has not condoned the late receiptofthecomplaintasisenvisagedinclause4.1.7

6.2 Forthepurposesofclause6.1,thetimeduringwhichamatterisbeforetheOmbudsmanshall(providedthatthecomplaintisacceptedforadjudication)commenceon the day that it is lodged with the Ombudsman’sofficetothetimethattheOmbudsmandismissesthecomplaintormakesaRuling.

6.3 Save as may be otherwise provided in the FinancialServicesOmbudSchemesAct37of2004asamendedorinanyotherlegislationrelatingtoorgoverningtheOmbudsman, the lodging of any complaintwith theOmbudsman shall in no way affect the running ofprescription intermsofthePrescriptionAct,1969 inrespectofsuchcomplaint.

7. Rulings7.1 Whenallthematerialfactsareagreedorthefactshave

beenestablishedtotheOmbudsman’ssatisfactiononabalanceofprobabilities,theOmbudsmanmaymakeaRuling.

7.2 Rulingsshallbebasedonthelawandequity.7.3 Whereamaterialfactcannotbeestablishedorcannot

be resolved on a clear balance of probabilities theOmbudsmanmay notmake a Ruling. In such casesthe Ombudsman shall advise the Complainant that the complaint is not one on which he or she can assist andthatalternativerecoursemaybesoughtthroughthecourts.

7.4 AnyRulingmadebytheOmbudsmanshallbebindingon the Insurer concerned save where an appeal againstsuchRulingisnotedasisprovidedinClause8below.

8. Right of Appeal against Rulings or Findings of the Ombudsman8.1 Anypartyaffectedbyanyformalrulingorfindingon

thepartof theOmbudsmanmayappealagainst theruling or finding of the Ombudsman, either in partor inwhole. In this context a “Ruling” shallmean, inrelation to a complaint received, “a written directive issued by the Ombudsman which is binding on theinsurerandwhichisbasedeitherinlaworequityandfairnessoracombinationoflawandequity”.“Finding”shall mean, with respect to a complaint, “a written directiveissuedbytheOmbudsmaninrelationtothecomplaintreceivedintermsofwhichtheOmbudsmanhas dismissed the complaint or declined to intervene inadisputebetweenthecomplainantandinsurer”.

8.2 No appeal against the ruling or finding of theOmbudsman shall be considered by any AppealTribunal,unless theOmbudsmanshallhavegrantedthe applicant leave to appeal against such ruling orfinding.

8.3 TheOmbudsmanshallonlygrant leave toappeal toanyappellantwhereheisoftheopinionthat:8.3.1 There isareasonableprospectthattheappeal,

either in whole or in part, if prosecuted, willsucceed; and

8.3.2 Thematterisoneofcomplexityordifficulty;or8.3.3 The rulingorfinding inquestion involves issues

orconsiderationswhichareofsubstantialpublic


or industry interestor importanceor it is in theinterestofjusticeorpublicpolicythattherulingordecisionbeconsideredbyanAppealTribunal;or

8.3.4 Therulingordecisioninvolvesprinciplesof lawwherethelawmaybeconsideredtobeuncertainor unsettled; or

8.3.5 Thematterindisputeinvolvesthejurisdictionofthe Ombudsman to entertain the dispute; or

8.3.6 Theissuesareofsuchanaturethatthejudgmentororder soughtby theappellantwillnotbeofacademicrelevanceonlyandwillhaveapracticaleffectorresult.

8.4 Thepowertograntleavetoappealascontemplatedinthissectionshallnotbelimitedbyreasononlyofthevalueofthematterindispute,ortheamountclaimedorawardedbytheOmbudsman,orbyreasononlyofthefactthatthematterindisputeisincapableofbeingvaluedinmoney.

8.5 Notice of any intention to appeal against any rulingorfindingof theOmbudsmanshallbefiledwith theOmbudsmanwithin a periodof 30 calendar days ofthehandingdownof any rulingor finding and shallstatewhethertheappellantappealsagainstthewholeorpartoftherulingorfindingoftheOmbudsman,thefindingsoffactand/orrulingoflawappealedagainstand thegroundsuponwhich theappeal is founded.Thenoticeofintentiontoappealshallbeaccompaniedbyanapplicationforleavetoappeal.

8.6 ANoticeofCross-Appealshallbedeliveredwithin15calendardaysafterdeliveryoftheNoticeofAppeal,orwithinsuchotherperiodof timeasmay,upongoodcauseshown,bepermittedbytheOmbudsman.Theprovisionsoftheseruleswithregardtoappealsshallequallyapplytocross-appeals.A“cross-appeal”shallmeanaprocessbywhichtherespondentinanyappealproceedings,havingbeenadvisedbytheOmbudsmanof receipt of a notice of intention to appeal, wishesin turn to appeal against the terms of the ruling orfindingmade by theOmbudsman in relation to thecomplaintsubmittedtotheOmbudsman.

8.7 Where an appeal has been noted, or an applicationforleavetoappealhasbeenmade,theoperationandexecutionoftherulingorfindingoftheOmbudsmanshallbesuspended,pendingthedecisionoftheAppealTribunal on the matter, unless the Ombudsman, on theapplicationofapartyandongoodcauseshown,otherwisedirects.

8.8 UponreceiptofaNoticeofAppeal theOmbudsmanshall within a period of 5 business days thereafternotifyeveryotherpartytothedisputethataNoticeofAppealhasbeenreceived.

8.9 All documentation in connection with any appealproceedings including the notice of intention toappeal and theapplication for leave toappeal, shallbe served upon the office of the Ombudsman byhand or alternatively by way of registered post orby e-mail save where the Ombudsman shall haveexpresslyconsentedtoanyothermethodofservice.Documentation served upon the Ombudsman shall be in A4 format and shall be clearly legible andcapable of being photocopied. Wherever possible,original documents should form the subject of anyappealproceedingsbutcopiesofdocumentsshallbeacceptablesubjecttotheprovisionsofthesetermsofreference.

Applications for Leave to Appeal8.10 Anypartywhodesirestoappealagainstanyrulingor

findingoftheOmbudsmanshall,within30calendardaysofthehandingdownbytheOmbudsmanofany

finalrulingorfinding,serveupontheOmbudsmanasprovidedforherein,aNoticeof intentiontoAppeal,together with an Application for Leave to Appealwhichshallsetoutthebasisfortheproposedappealas contemplated inClause8.5above, togetherwithreasonswhyLeave toAppealagainstsuchrulingorfindingshouldbegrantedby theOmbudsman.Thegrantingofleavetoappealshallbeapre-requisitefortheprosecutionofanyappeal.

8.11 Failing receipt by the Ombudsman of any Noticeof Appeal within the time period referred to inparagraph8above,thefinalrulingorfindingbytheOmbudsman shall become final and binding uponthe parties and shall be carried into effect withoutfurtherdelay.

8.12 AnylatefilingofaNoticeofAppealoranApplicationforLeavetoAppealshallbenullandvoidsavewhereaccompanied by an application for condonationfor the late filing of the appeal. Any application forcondonation must set out in full the reasons whycondonationshouldbegranted,thereasonsforanynon-complianceandthatthematterisoneworthyofconsideration.

8.13 TheOmbudsman, after considering any applicationforcondonation,maygrantorrefusesuchapplicationinhisdiscretion.

8.14 Where leave to appeal against any ruling or findingof the Ombudsman is refused by the Ombudsman,the unsuccessful party may, within 15 business daysof notification of such refusal, petition the Chairmanof the Appeal Tribunal, to review the decision of theOmbudsmannot togrant leave forappeal.ThesameprovisionshallapplymutatIsmutandistoanyapplicationforcondonationforthelatefilingofanappeal.

8.15 AnysuchrequestshallbeaddressedtotheChairmanoftheAppealTribunalviatheOmbudsmanwhoshallconveysuchrequest to theChairmanof theAppealTribunal.TheChairmanof theAppealTribunalshallwithinareasonableperiodof timebut inanyeventnot later than a period of 15 calendar days of thereceiptofanysuchpetition,eitherconfirmoramendthe decision of theOmbudsmannot to grant leavetoappealor refusal to condoneanyapplication forthe late filing of an appeal. The Ombudsman shallthereafterwithinaperiodof5businessdays,informthepartiesaccordingly.

Appeals8.16 An appeal against the ruling or finding of the

Ombudsman shall be heard by an Appeal Tribunalwho shall consider the matter as if it were theOmbudsmanand shall include the considerationofproceduralaswellassubstantivematterspertainingtotheobjectionraisedbysuchpartytothedecisionoftheOmbudsman.

8.17 The Appeal Tribunal may, where it considers itnecessary or in the interests of justice, permit theleadingofevidenceornewevidenceonanymatter,even if the Ombudsman himself did not hold ahearing,or receiveevidenceonanymatterprior tomakingafindingonanycomplaintreferredtohim.

8.18 Where the Appeal Tribunal decides to permit, orcalls for the leading of evidence, or evidence isled on material that was never considered by theOmbudsman, the tribunal may decide, in its solediscretion to invite the Ombudsman to consider the matter in the lightof suchevidenceand tocanvassthe views of the Ombudsman on the matter. TheOmbudsman should be invited to comment on the new material in the manner and on such terms as it mayregardtobefairtobothparties.


8.19 Savewhere theAppealTribunalpermitsorcalls fortheleadingofevidence,noevidenceshallbeledandthematter shall be decidedby theAppeal TribunalonthebasisoftherecordofappealfurnishedtoitbytheOmbudsman, including thedocumentationfiledbythepartiesinconnectionwiththeappeal.

8.20 Therecordofappealshall,savewhereintheopinionof the Ombudsman additional documentation isrequired,consistofthefollowing:-

8.20.1 The complainant’s Application for Assistanceformandsupportingdocumentation;

8.20.2 Theinsurer’sresponsetothecomplaint;8.20.3 The complainant’s reply to the insurer’s

response to the complaint;8.20.4 The Ombudsman’s finding in relation to the

complaint and any reasons furnished by theOmbudsmanforanyrulingorfinding;and

8.20.5 The submissions or representationsmade bythe parties to the Appeal Tribunal in connection withtheappeal.

8.21 The Ombudsman may, in his discretion, whensubmittingthedocumentationtotheAppealTribunalinconnectionwithanyappeal,makerepresentationsto the Appeal Tribunal by way of explanation orelaborationofhisearlierdeterminationandshallbeentitled in such representations to deal with such mattersaspolicy,industrypracticesandtheapproachfollowedbyhim in regard toequity. Inaddition theOmbudsmanmay furnish the Appeal Tribunal withsuchother informationashemayconsidertobeofassistanceorguidance to theAppeal Tribunal, savethat thepartiesshallbeaffordedanopportunity torespondtoanysuchadditionalmaterialthusplacedbeforetheAppealTribunal.

8.22 Save as aforesaid, the Ombudsman shall notparticipate in the appeal process save where he should be asked to do so by the Appeal Tribunalitselfonsuchtermsand insuchmannerasmaybedeterminedbytheTribunal.

Composition of the Appeal Tribunal8.23 TheChairmanoftheBoard,inconsultationwiththeVice-

Chairman, must appoint the members of the AppealTribunalfromthepersonsnominatedbytheOmbudsman.

8.24 The Appeal Tribunalmust consist of a Chairpersonandatleasttwomembersappointedforaminimumperiodoftwoyears.

8.25 The Chairman of the Board must appoint theChairperson of the Appeal Tribunal and suchChairperson must either be a retired Judge or apracticing Attorney or Advocate, or a person whoformallypracticedasanAttorneyorAdvocate,withat least ten years’ experience andwith appropriateexperienceinInsuranceLaw.

8.26 TheChairpersonoftheAppealTribunalisresponsiblefor assigning matters for adjudication, taking intoconsideration the nature and complexity of thedisputeoranyspecialcircumstance,toapaneloftwoor moremembers of the Appeal Tribunal who aresuitablyqualifiedtodecideonaparticularmatter.

8.27 TheChairmanofthepanelmustbetheChairpersonoftheAppealTribunal.

8.28 Theperson’snominatedbytheOmbudsmanmustbe:8.28.1Practicing Attorneys or Advocates or persons

who formerly practiced as an Attorney orAdvocate, with at least ten years’ experienceand with appropriate experience in Insurance Law,andmayincluderetiredJudges;or

8.28.2 Personswith extensive experience in relationtotheinsuranceindustryandwhobyvirtueoftheir knowledge, training and experience areabletoperformthefunctionsofamemberofthe Appeal Tribunal; or

8.28.3 Academics with the particular knowledge ofspecificareasofthelaworpersonsofspecificknowledge, skill or training whose expertiseas an expert in any particular field may beappropriate.

8.29 The Chairman of the Appeal Tribunal may, inconsultationwiththeChairmanoftheBoardandtheOmbudsman, appoint a person who is not a member oftheAppealTribunaltoserveonthepanelifintheopinion of the Chairperson of the Appeal Tribunalsuchappointmentismeritedordeemeddesirable.

The Hearing of Appeals8.30 TheOmbudsmanshallbeinchargeofallpracticalor

administrativemattersprecedingandrelatingtothehearingofanappealandshallberesponsibleforthepreparationof the record, thegivingofnoticesandthe making of arrangements for the hearing of anappeal,therecordingofevidence,ifany,andallsuchothermattersincidentaltothehearingordisposaloftheappeal.

8.31 The Appeal Tribunal shall determine its ownprocedurebothpriortoandduringthecourseofthehearing,includingthehearingoforalevidence.

8.32 Appealsshallbeheardatsuchplaceandtimeandinsuch manner as the Appeal Tribunal shall determine fromtimetotime.

8.33 Notlaterthan10businessdaysbeforethehearingofanappeal, the appellant shall deliver to the Ombudsman aconciseandsuccinctstatementofthemainpointswhichheintendstoargueonappeal,aswellasthelistoflegalauthorities(ifany)tobetenderedinsupportofeachpointtoberaised.Notlaterthan5businessdaysbeforethehearingofanappeal,therespondentshalldeliverasimilarstatement.

8.34 The Chairman of the Appeal Tribunal may, afterconsultation with the Ombudsman, direct that a contemplated appeal be dealt with as an urgentmatter and that the appeal be prosecuted at such time and in such manner as the Chairman of theAppealTribunaldeemsappropriate.

8.35 TheAppealTribunalshouldapproachthematteronappeal put forward as if it were the Ombudsmandeterminingthecomplaint.TheAppealTribunalshalltakeintoaccountthebalanceofprobabilitiesanditsfinding shall bebasedon the criteria of law, equityandfairness.

8.36 The Appeal Tribunal shall deliver its judgment onthematterinwritingtotheOmbudsmanwithinonecalendarmonthoftheconclusionofthehearing.TheOmbudsman shall in turndeliver a copy thereof tothepartieswithinaperiodof10businessdays.

Representation8.37 Any party to any appeal shall have the right to be

represented at the hearing but, wherever possible,the parties should confine their submissions inregard to matters before the Appeal Tribunal towrittensubmissionscontainedinastatementofcaseincluding,whereappropriate,headsofargument.

8.38 Anypartywhoemploysarepresentativetorepresenttheir interest before the Appeal Tribunal shall bepersonally responsible for any fees and expensesassociatedwithsuchrepresentation.


The Effect of the Decision and Order of the Appeal Tribunal

8.39 Where a complainant appeals against the ruling orfindingoftheOmbudsman,suchpersonshallabidebythedecisionoftheAppealTribunalandtheorderof theAppeal Tribunal shall be final andbinding inrelation to theproceedingsbefore theofficeof theOmbudsman. The complainant shall however beentitled,ifsodesired,tothereafterpursuethematterfurtherinanycourtoflaw.

8.40 Anunsuccessfulappellantinsurershallhavenofurtherrightofrecourseoractionandshallbeboundbytheterms of the order of the Appeal Tribunal save thatnothing contained herein shall in any way affect theright of an insurer to review any rulingmade by theOmbudsmanortheAppealTribunalinacourtoflaw.

Precedent8.41 Inrecognitionoftherequirementthatrulingsmadeby

theOmbudsmanshallnotestablishanyprecedent intheOmbudsman’s office, thedecisions of theAppealTribunal shall not be accorded any formal status orregardedascreatingbindingprecedents,butmayserveasguidelinesforfuturecases.Suchfindingsorordersmayhowever,serveasstrongpersuasivevaluefortheOmbudsmanandanyotherAppealTribunalinwhichthesamedisputemayberaisedsoastoensureconsistencyinthedecisionsoftheofficeoftheOmbudsman.

Cost to the Parties to Appeals8.42 Where an insurer notes an appeal against any final

rulingoftheOmbudsmanandisnot,intheopinionofthe Chairman of the Appeal Tribunal, successfulwithsuch appeal, it shall defray the cost of such appealincurred by the Ombudsman in connection with theappealproceedings.

8.43 Wheretheinsureristheappellantinanyproceedings,savewheretheChairmanoftheAppealTribunalmaydirectotherwise, thecosttobepaidbythe insurer inrelationtoanyappealproceedingsmaybedeterminedby the Board of the Ombudsman for Short-termInsurance,fromtimetotime.

8.44 Wherethecomplainant istheappellant inanyappealproceedingstheOmbudsmanmay,inhisdiscretionandtakingintoaccount,interalia,theamountoftheclaim,the complexity of the issues and the complainant’spersonalcircumstances,calluponsuchpartytopayadepositinanamountdeterminedbytheOmbudsmanwhichdepositshallberefundedtotheappellantshouldtheappellantbesuccessfulintheappeal.Intheeventthattheappealfails,thedepositshallbeforfeitedtotheofficeoftheOmbudsmanandshallconstitutetheonlyliabilityonthepartofthecomplainantforthecostsoftheappealproceedings.Iftheappealis,intheviewoftheAppealTribunal,successful,theamountpaidbytheappellantshallberefundedtotheappellant.

8.45 In no case shall the Appeal Tribunal award costs infavourofasuccessfulpartyandinnocaseshallalosingpartytoanappealbeorderedbytheAppealTribunaltopaycoststotheotherparty,savewheretheChairmanoftheAppealTribunalconsidersthat,havingregardtothepresenceofexceptional circumstances,apunitiveorderastocostsagainstanypartyismerited.

9. Policyholder/Complainant’s Rights The Policy Holder/Complainant’s rights to institute

proceedings inanycompetentcourtof lawagainst theInsurer shall not be affected by any of the provisions

of these termsof referenceprovidedthat, if thePolicyHolder/Complainant institutes proceedings while thecomplaintisunderinvestigationbytheOmbudsman,theprovisionsofclause4.2shallapply.

10. Precedents Rulings shall not establish any precedent in the

Ombudsman’soffice.

11. Confidentiality11.1 The Ombudsman shall a far as possible, maintain

confidentialityunlessthepartiesconcernedexpresslyexempthimorherfromthatdutyandthedutyshallcontinueaftertheterminationofhisorherservices.Thedutyofconfidentialityshallhowever,notpreventtheOmbudsmanfrom:

11.1.1 Publishingdetailsofrulingsmadebyhimorher.11.1.2 Reporting on details of rulings or furnishing

statistical information in connection with theworkings of the office to the South AfricanInsurance Association (SAIA), the FinancialServices Board (FSB), the National Treasuryoranyotherbodyororganisationwhichmaybe entitled to receive such information fromthe Ombudsman in connection with his/heractivities and/orwhichmay have a legitimateinterest in such information, having regardto its statutory mandate, role as an industryassociationorotherwise.

11.1.3 PublishingstatisticsandrelatedinformationintheAnnualReportoftheAssociationconcerningcomplaints received by the Ombudsmanagainst members of the Association asapprovedbytheBoardoftheOmbudsmanforShort-termInsurancefromtimetotime.

11.1.4 Filing, either on behalf of the Company, or anycomplainantfromwhomacomplaintisreceived,acomplaintwithSAIAinconnectionwithanyCodeofConductapplicableto or adopted by that organisation and which may beapplicabletoanymemberoftheCompany.11.2 TheInsurerandtheComplainantshallnotbeentitled

to make use of any information which comes totheirknowledgeasaresultoftheinterventionoftheOmbudsmanduring thecourseofany investigationbyhimorher.

11.3 A complaint will be regarded as confidential asbetween the Policy Holder, the Insurer and theOmbudsmananditisfortheOmbudsmantodecidewhat shouldbedisclosed to the Insurer and/or thePolicyHolder.

11.4 Documents brought into being as a result of anyapproach to the Ombudsman shall not be liable todisclosureorbe thesubjectofadiscoveryorderor subpoena in the event of any legal proceedingsbetweentheComplainantandtheInsurer.

11.5 TheOmbudsmanoranymemberofhisstaffwillnotbe liable tobesubpoenaed togiveevidenceon thesubjectofacomplaintinanyproceedings.

12. Complaints not settled in defined periodThe Ombudsman shall report to the Board all complaints, which have not been completed in one orway or anotherwithinatime,laiddownbytheBoard.Thistimeperiodshallinitiallybesetat6(six)monthscalculatedfromthedatethatacomplaintbecameanacceptedcomplaint.


AsOSTI’slegalinternswehaveobservedthatconsumersofinsuranceproductsgenerallylackanunderstandingofthebasicsofinsurancelaw.Commontoourobservationishowconsumersunderstandwhatthespecificfeaturesoftheirpoliciesarebutnothowthecoverwillbeapplied.This discussion looks at some of these problems andgeneralmisunderstandingsofhowinsuranceworksandendeavours to explain some of these concepts to theconsumerinthesimplestterms.

“Why am I paying monthly premiums if the insurer is not going to honour my claim?”

Consumersoftenassumethatpayingpremiumsmonthlyis thecatchallprerequisite foravalidclaim.What theyrequirefromtheOmbudsmanisanexplanationastowhytheirclaimsarebeingrejectedwhentheyhavecompliedwiththemonetaryobligationsofthecontractbymakingregularpaymentoftheirpremiums.Inadditiontopayingpremiums, the consumermust complywith the termsandconditionsof the relevantpolicy inorder for theirclaimtobevalid.Toillustrate,whereitisaconditionofthepolicytoinstallatrackingdeviceinamotorvehiclefortheftandhijacking;failuretocomplywiththisconditionwillresultintherepudiationoftheclaimintheeventoftheftorhijackingofthevehiclenotwithstandingthefactthatpremiumsareuptodate.

“My policy was cancelled, I want a refund of my premiums since inception of the policy because I have never claimed under the policy.”

Thereisalsoanotherperceptionheldbyconsumersthatbecauseno lossordamageoccurredwhich the insurerwas calledupon to settleduring the subsistenceof thepolicytheinsurerisnotentitledtoretainthepremiumscollected during this period once a policy is cancelled.Shortterminsurancepoliciesprovidecoveronamonthlybasis.Thepartiesagreethattheinsured’sexposuretotheriskoflossofordamagetopropertywillbetransferredtothe insurer inexchangeforthepaymentofapremium.If the risk materializes, the insurer will indemnify theconsumer provided that the terms and conditions are also met.Ifnoriskmaterializestheinsurerwillstillbeentitledtoretainthepremiumforthatperiod.Thisisbecausethepremiumispaymentforthe exposuretotheriskandnotpaymentforanactualloss.

“I was not informed that my premiums were in arrears now my claim is rejected on the ground of non-payment of premiums.”

osti’s interns on consumer literacy

Anotherdetrimentalassumptionmadebyconsumersis that it is the duty of the insurer to inform themwhenpremiumsarenotpaid. Itmustbeunderstoodby consumers that the most important undertakingbyan insured is theundertaking topaypremiums tothe insurer for carrying the risk onhis or her behalf.Accordingly it follows that it remains the consumer’sdutytoensurethatpremiumsarepaid.

(Tlotlego Tsagae, Vuyisile Ramakoaba and Respect Masuku)

“I have insurance for damage or loss to property, why is the insurer now refusing to pay my claim?”

Oftenthetypeofpolicysoldtoconsumerscontributesto the misunderstanding held by consumers.Consumersassume that the typeof cover theyhavecoverseveryeventthattheymaysufferorthatalloftheirlosswillberecoveredfromtheinsurer.Thetermsand conditionsof thesepolicieswill setout indetailwhat is covered and what is not covered, under what circumstancesthedamageorlosswillbecovered,theprocedurestofollowtoenjoycoverandtheamountofcompensationthatcanberecoveredfromtheinsurer.

Forexample,AllRiskCoverrefersto insurancecoverfor losses arising fromany unforeseen event exceptfor events that are specifically excluded. The policywill list what is excluded from cover. It is thereforesomething of amisnomer to use the term “All RisksCover” asnotevery risk is coveredunder thepolicy.Typical exclusions are wear and tear, mechanicalfailure or breakdown, gradual deterioration and thelike.

(Relebohile Mashego)

ConclusionWehaveobservedthatthemajorcontributingfactorto consumer misunderstanding is that consumersassume that insurers inform themof the terms andconditionsofthepolicy.Itremainsincumbentontheinsuredtoreadandunderstandthetermsofthepolicyand to seek clarity where there is uncertainty. Weurgeconsumerstoreadtheirpoliciesandrequesttheinsurerstoclarifyanyissuestheymighthave.


members of the ombudsman scheme

Abacus Insurance Limited

Absa Insurance Company Limited

AIG Insurance Company

Alexander Forbes Insurance Company

Allianz Global Corporate

Auto & General Insurance Company

Bidvest Insurance Limited

Bryte Insurance Company Limited

Budget Insurance Company Limited

Centriq Insurance

Chubb Insurance South Africa Limited

Compass Insurance Company Limited

Constantia Insurance Company Limited

Dial Direct Insurance Limited

Discovery Insure

First for Women Insurance Company Limited

GENRIC Insurance Company Limited

Guardrisk Insurance Company Limited

Hollard Insurance Company

Indequity Specialised Insurance Limited

Infiniti Insurance Limited

King Price Insurance Company Limited

Legal Expenses Southern Africa Limited

Lion of Africa Insurance Company Limited

Lloyd’s South Africa (Pty) Limited

Lombard Insurance Limited

MiWay Insurance Limited

Momentum ST Insurance Company Limited

Monarch Insurance Company Limited

Natsure Limited

Nedgroup Insurance Company Limited

New National Assurance Company Limited

NMS Insurance Services (SA) Limited

Oakhurst Insurance Company Limited

Old Mutual Insure Limited

OUTsurance Insurance Company Limited

Professional Provident Society Short-term Insurance Company LimitedRegent Insurance Company (now Hollard Specialist Insurance Limited)

Relyant Insurance Company Limited

Renasa Insurance Company Limited

RMB Structured Insurance Limited

SAFIRE Insurance Company Limited

SAHL Insurance Company Limited

Santam Limited

SASRIA SOC LIMITED

Shoprite Insurance Company Limited

Standard Insurance Limited

Sunderland Marine (Africa) Limited

Unitrans Insurance Limited

Vodacom Insurance Company Limited

Western National Insurance Limited

Workerslife Insurance Limited


useful information about other offices

1. Ombudsman for Long-TermInsurancePrivateBagX45,Claremont7735Telephone:0216575000Sharecall:086 0103236Fax:0216740951E-mail:[email protected]:www.ombud.co.za

2. Financial Advisory and Intermediary Services Ombud546JochemusStreet,ErasmusKloof,KasteelPark2nd FloorSharecall:0860324766Telephone:012 470 908/0127625000Fax:0123483447E-mail:[email protected]:www.faisombud.co.za

3. The Ombudsman for BankingServices34-36FrickerRoad,GroundFloor,Illovo,JohannesburgSharecall:0860800900Telephone:0117121800Fax:0114833212E-mail:[email protected]:www.obssa.co.za

4. Credit OmbudPOBox805,Pinegowrie,2123CallCentre:0861662837Tel:0117816431Fax:011 3888250E-mail:[email protected]:www.creditombud.org.za

5. Motor Industry Ombudsman of South AfricaSuite156,PrivateBagX025,LynnwoodRidge,0040Telephone:010 5908378CallCentre:086 1164672Fax:0866306145E-mail:[email protected]:www.miosa.co.za

6. Consumer Goods and Services Ombud292SurreyAvenue,Ferndale,Randburg,2194Telephone:0117812607CallCentre:0860000272Fax:086 2061999E-mail:[email protected]:www.cgso.org.za

7. Ombudsman Central HelplineSharecall:0860OMBUDS/0860662837

8. Pension Funds AdjudicatorPOBox580,Menlyn,0063Telephone:0123461738Fax:0866937472E-mail:[email protected]:www.pfa.org.za

9. National Credit Regulator127,15thRoad,Randjespark,MidrandCallCentre:0860627627E-mail:[email protected]:0115542600Fax:087 2347822Website:www.ncr.org.za

10. Public ProtectorPrivateBagX677,Pretoria,0001Telephone:0123667000Fax:0123623473Tollfreenumber:0800112040E-mail:[email protected]:www.publicprotect.org

11. Financial Sector Conduct Authority POBox35655,MenloPark,0102Toll-free:0800203772Telephone:0124288000Fax:0123466941E-mail:[email protected]:www.fsca.co.za

12. National ConsumerCommissionPrivateBagX84,Pretoria,0001Tel:0127613200Fax:086 7584990E-mail:[email protected]:www.nccsa.org.za

13. City of Johannesburg Ombudsman48AmeshhoffStreet,BraamfonteinSappiBuildingCallCentre:010 2882800Website:[email protected]

14. National Consumer TribunalTelephone:0126838140/0127429900Fax:0126635693E-mail: [email protected]:PrivateBagX110,Centurion,0046

15. Office of the Tax OmbudMenlynCorner,2nd Floor,87FrikkieDeBeerStreet,Menlyn,Pretoria,0181Telephone:012 4319105CallCentre:0800662 837Fax:012 4525013E-mail:[email protected]

16. S.A. Military Ombudsman PrivateBagX163,Pretoria0046Telephone:0126763800Tollfree:0807266283E-mail:[email protected]

PostalAddress:POBox32334,Braamfontein,2017Tel:+27117268900| Fax:+27117265501| Sharecall:0860726890

Website:www.osti.co.za| E-mail:[email protected]

One Sturdee-1SturdeeAvenue,FirstFloor,BlockA,Rosebank,Johannesburg,2196

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