Have you ever been frustrated with being unable to resolve an issue or dispute with your car insurance company? Or unsatisfied with the way in which your dispute was resolved? Well, help is here in the shape of the Car Insurance Ombudsman! Although we hope that you won’t need this information, we assume that if you are reading this then you are not very happy with your insurance company and are considering filing a complaint. If so, let’s hope to it (no, I am not 90 years old) and learn more about how to file a complaint with the car insurance ombudsman.
So, who is the Ombudsman?
The official name is “The Office of the Ombudsman for Short-Term Insurance” and it was established in August, 1989, as a means of providing a complementary and efficient mechanism for resolution of disputes between insurance companies and their customers. The Ombudsman functions as an impartial mediator or arbitrator without representing either the consumer or the insurance companies in South Africa.
This is an extremely beneficial and important service for consumers to utilize when necessary as some insurance companies aren’t always as cooperative as we would like them to be (not that they are always to blame, especially with the high rate of insurance fraud in SA). The Ombudsman Office is an independent office whose decisions are binding for the car insurance companies in South Africa. Filing a complaint with the car insurance ombudsman will cost you nothing, so read on to find out exactly how to file that complaint.
How to File a Complaint with the Car Insurance Ombudsman
Before filing your complaint with a car insurance ombudsman, you must voice your complaint with your car insurance company first. When doing so, it is best to:
- Put your complaint in writing if possible. Otherwise, when lodging the complaint by phone, it is critical that you take down and keep the basic information related to your claim, such as the name of the person with whom you spoke, the date and time, details of the conversation and the conversation tracking number (not all call service centers provide this). This may be necessary at a future time. If possible, record the conversation.
- Keep a copy of any written documentation and correspondence between you and the insurance company and any documentation you send them – this is crucial and will prevent you from mistakenly changing the facts at a later stage, which will make you look untrustworthy.
- Remain calm and speak respectfully even when you do not feel your complaint is being heard or handled appropriately (this may be easier said than done, but well worth it as it will help get others on board at a later stage – the Ombudsman or perhaps a judge).
- Seek higher officials within the insurance company if your complaint cannot be resolved by a representative. If no initial response is returned, keep calling and keep asking for a manger. Don’t forget to document these attempts (date, representative name and so on)
Ok, so assuming you have now attempted to solve the problem with the insurance copany for the zillionth time, and yet, still no response or you are unhappy with their decision – that’s where the ombudsman comes in.
How to file a complaint with the car insurance ombudsman is a simple process:
Complete a complaint form from the Office of the Ombudsman for Short-Term Insurance and post (see address in the form), email ([email protected]) or fax ((011) 726-5501) it back to them. You can find more details here: http://osti.co.za/steps-to-lodge-complaint.html. When returning your complaint form, it is important to include any relevant documentation.
Once you have filed your complaint, make sure to keep copies of all the necessary paperwork, as well as follow up to determine the outcome of your complaint. Remember, this is your complaint, so you need to stay on top of it. It is also important to note that the ombudsman can’t always help. Nevertheless, there are always other options such as small claims court (see more on this below)
Just in case we didn’t answer all you wanted to know, here are some common questions regarding the car insurance ombudsman and the whole process.
Frequently Asked Questions
Q. Under what circumstances will the Office of the Ombudsman for Short-Term Insurance not be of assistance to me?
The ombudsman cannot officially deal with issues/disputes that are related to:
- Personal injury or death claims as a result of a road accident.
- Situations that involve other people’s insurers, as opposed to your own.
- Situation in which litigation against the insurer has already begun.
- Cancellation of insurance, unless there was a claim pending prior to cancellation.
- General legal service – the ombudsman is not a source of free legal advice.
- Commercial or business insurance related matters
- How long does the process take? What is the process?
Q.How long does the process take? What is the process?
The Office of the Ombudsman for Short-Term Insurance takes your complaints seriously. As such, they will not finalize a decision until all information has been considered. Overall, claims can take from three months to over a year, depending on the complexity of the situation. While they encourage people to wait for their decision, you nevertheless still have the right to pursue legal action which will result in a quicker resolution. However, it often incurs greater cost.
The basic process is as follows:
- The Ombudsman’s office looks at your initial complaint to determine jurisdiction and then either (a) sends an application and allocates a reference number or (b) makes an informal suggestion as to what you might do to address your claim. In some cases the Ombudsman might request additional information before proceeding.
- Once your application is received, you will be notified in writing, as will your insurance company. Your car insurance company will be asked for a formal response to the complaint. At this point, all time limits are suspended.
- Your complaint will not be reviewed until the Ombudsman’s office has received the formal response from the insurance company. Herein lies one of the reasons for the delay! (Absurd, we know!)
- You are subsequently asked to comment on the insurer’s response and possibly to provide additional information or documentation.
- The decision stage – the Ombudsman’s office will decide your case! The rulings range from being in favor of the insurance company, to arranging a meeting between consumer and insurance company if that might facilitate a resolution, to giving a formal ruling if the situation relates to interpretation of policy or to declining to rule if there is a lack of evidence.
Q. Is filing a complaint with the Ombudsman my only free option?
No. You can open a claim in Small Claims Court, which will be heard by an attorney or advocate. There is a minimal cost involved, but it is important to note that the maximum amount that can be claimed through this course is R12,000 (last updated in October 2010). If you need to file a claim for a larger amount, you should consider getting advice from a lawyer (see our List of Lawyers).
Q. What is the statute of limitations on filing a complaint against my insurer?
That’s a slightly more complicated question. As a general rule there is a three year time limit for bringing up legal civil matters. However, you might find that your insurance contract has a time limit for these issues (usually 30, 60 or 90 days), so you’ll need to check that. As for filing a complaint with the ombudsman, that depends on your situation, since you could file a complaint with your insurance company on time but then need the help of the ombudsman later. However, it never hurts to try, so even if you think you might be outside of any time limits you have nothing to lose by filing a complaint anyway (and possibly a lot to gain)!
And if your not happy with your insurance provider, why not check what other companies are offering?
If you have a dispute or claim against your car insurance company, then the first step is to inform the insurance company, ideally in writing, but if not then at least by phone, and try to work things out with them. Only after doing this, and assuming that you are dissatisfied with the result, then you should contact The Office of the Ombudsman for the Short-Term Insurance for help. As an independent office, they can investigate your dispute further and give you another avenue to pursue your claims. While it may take slightly more time and effort on your part, as well as the addition wait for a resolution, at least you will know you have taken one more step towards trying to reach a satisfactory response.
Car Insurance Ombudsman contact details:
Email: [email protected]
Postal Address: P O Box 32334 Braamfontein, 2017.
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