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Monday 08:00 - 16:30 Tuesday 08:00 - 16:30 Wednesday 08:00 - 16:30 Thursday 08:00 - 16:30 Friday 08:00 - 16:30

The Insurance Ombudsman

Name: The Insurance Ombudsman
Address: 1 Sturdee Avenue, First Floor, Block A, Rosebank, Johannesburg, 2196, ZA
Telephone: +27860103236
Rating: 3.4

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The Insurance Ombudsman

The Insurance Ombudsman offers a free, efficient & fair dispute resolution mechanism for insured consumers with insurance claims complaints.

The Office of the Ombudsman for Short-Term Insurance offers consumers a “no risk” mechanism to resolve disputes with insurers. The Office can assist consumers with the following personal lines short-term insurance:
- Motor
- Houseowners (Buildings)
- Householders (Contents)
- Cell phone
- Travel
- Disability
- Credit protection insurance
- Commercial Insurance on a Limited basis, i.e. claimants su

ch as small businesses, including a sole proprietor or trader, a juristic person, partnership or trust that has a turnover in the last financial year of less than R25 million. Claim disputes, which the Office can assist with, include fire and allied perils, glass, theft, motor, travel, sickness and accident and SASRIA claims (affiliated to the aforesaid covers). The Office of the Ombudsman for Short-Term Insurance has been granted recognition in terms of the provisions of the Financial Services Ombud Schemes Act. Personal lines short-term insurers, who are members of this office, have agreed to abide by the Ombudsman’s decision. The Ombudsman’s task is to act as a “mediator” or informal arbitrator and he/she does not represent either of the parties to the dispute. Important points to remember:
- You must complain to your insurance company first and only if you are unable to resolve the dispute with your insurer, then you can refer the matter to the Ombudsman’s Office.
- The Ombudsman’s decisions are binding on the insurance company but not on you.
- The Ombudsman’s Office is an independent office.
- The Ombudsman’s decisions can be based on law and equity.
- The Ombudsman’s Office does not give legal advice.
- The service is free to insured consumers

The office for the Ombudsman for Long-term Insurance was established in 1985. The function of the office is to mediate in disputes between subscribing members of the long-term insurance industry and policyholders regarding insurance contracts. It is an independent office which is accountable to an independent Long-term Ombudsman Council for providing an efficient and independent service to policyholders and others in response to disputes arising from long-term insurance policies. Policyholders who submit a complaint to the Ombudsman may still decide to follow the conventional civil justice process, although these two processes are not allowed to proceed simultaneously. The service is free to complainants. Industry subscribers are bound by the Ombudsman’s rulings. There is provision in the rules for an informal appeal process. In achieving its mission, the office strives towards: Informality; ready access; cost effectiveness; speedy resolution of disputes; mediation rather than adjudication; and the right to afford due weight to equity. Any policyholder, a successor in title, beneficiary, life insured or premium payer of a long-term or life insurer who subscribes to the Ombudsman scheme, can lodge a complaint. We commonly receive complaints relating to:
• Conclusion of contracts of insurance
• Interpretation of proposal forms and policy provisions
• Life policies
• Disability benefits
• Annuities
• Funeral benefits
• Credit life insurance policies
• Health policies
• Rejection of claims by insurers because of:
o non-compliance with policy provisions
o pre-existing conditions
o non-disclosure
o fraudulent claims
• Cancellation of policies by policyholders because of:
o Misrepresentations
o Lapsing and re-instatement of policies
o Communication, administration and other errors by insurers
o Policy values

23/02/2024

Listen as Senior Assistant Ombudsman, Peter Nkhuna speaks to Vuma FM about the importance of updating insurance policies to ensure that your cover aligns with your current circumstances and the various types of coverage available to protect your possessions.

31/01/2024

Briefcase study 2: Failure to notify the tracking company of the theft of a vehicle.

After discovering the theft of her motor vehicle, the insured only notified the tracking company of the theft, some four and a half hours after discovering the loss. The insured’s claim for the theft of her vehicle was rejected by the insurer because the insured failed to take reasonable precautions to minimise the loss and, according to the insurer, the insured acted with gross negligence when she failed to notify the tracking company about the theft timeously.

Read more on the interesting outcome:https://www.osti.co.za/media/1632/osti_2023_briefcase_3rd_edition.pdf

29/01/2024

Briefcase study 1: Theft of a motor vehicle not reported to the police immediately.

The insured’s motor vehicle was stolen from a family member’s home. The claim was rejected by the insurer on the basis that the insured failed to report the theft to the police immediately after discovering it. The insurer said that the insured breached a policy condition and, therefore, it was entitled to decline liability for the claim.

Read more on the interesting outcome here:https://www.osti.co.za/media/1632/osti_2023_briefcase_3rd_edition.pdf

22/01/2024

January brings with it a fresh start and, quite often, heavy rains. The rainy season can bring with it some devastating outcomes for many South Africans. Please ensure that you have adequate cover and remember to check that your property is properly maintained and sufficiently waterproofed to prevent storm damage.

If you feel that your claim was unfairly rejected contact us, send your complaint to [email protected] for us to investigate.

17/01/2024

The holidays are over, and the bills are starting to pile up. In January It can be tough to make ends meet, especially after all the spending of the festive season.

• It is important to remember that when you take out a policy you must pay your premiums to ensure that your cover is in place.

• No benefits will be paid if premiums are unpaid.

• If you are having financial difficulties speak to your Insurer about a grace period to pay your premium.

15/01/2024

Kick off the new year the right way by making short-term insurance a priority! As we bid farewell to the old year and welcome the year, it's the perfect time to give your insurance policies a checkup too.

• Review your coverage: Have your needs changed since you last took out your policies? A new car, a growing family, or even a planned home renovation might necessitate adjustments to your coverage.

• Check for gaps: Are there any potential vulnerabilities in your existing coverage? Don't wait until disaster strikes to find out you're underinsured.

• Compare premiums: It's always a good idea to shop around and compare quotes from different insurers to ensure you're getting the best value for your money. Remember, the cheapest option isn't always the best!

12/01/2024

: While making your New Year's resolutions you should consider adding "insurance review" to the list. It's a simple step that can have a big impact on your financial security and well-being in the months to come.

• Set calendar reminders: Schedule regular checkups of your insurance policies, at least once a year, to ensure they remain up-to-date.

• Keep your information updated: Inform your insurer of any changes in your life, such as a new address or a change in marital status, to avoid coverage gaps.

20/12/2023

Happy Holidays 🎅💝!

11/12/2023

: Make sure you and your vehicles are safe while driving on the roads this festive season
• Take your car in for service or an inspection before a long trip
• Ensure tyres are correctly inflated?
• Correct fuel used and enough fuel?
• Take breaks to avoid fatigue
• Don't drink and drive
• Wear your seatbelt
• Be patient and courteous to other drivers.

06/12/2023

: Make Choosing the right travel insurance policy a priority this festive season.
•Make sure the policy adequately covers the risks you'll be facing on your trip.
•Shop around and compare policies from different insurers to find the best deal suited for you.
•Ask questions, carefully read and understand the policy before you purchase it.

05/12/2023

With the festive season in full swing, we can expect an increase in petty crimes and accidents. We urge everyone to adequately insure their assets and practice due care. For those who are planning to travel, make sure you have travel insurance in place. Short term insurance can come to your rescue if your plans do not go as planned.

27/11/2023

OSTI is a free and impartial dispute resolution service for consumers who have a problem with their short-term insurer. If you're having trouble getting your insurer to pay your claim contact us via our website at www.osti.co.za, click on Lodge a Complaint and then follow the prompts or contact our office by calling
011 726 8900 or our share-call number on 0860 726 890.

22/11/2023

Briefcase study: Non-compliance with inspection requirement

The insured submitted a claim for the theft of her vehicle. The insurer declined liability for the claim on the basis that the insured had not taken the vehicle for an inspection when the policy was concluded and, therefore, there was no cover in force.

Read more on the interesting outcome of the case here:https://www.osti.co.za/media/1611/osti_briefcase_2nd_ed_2023.pdf

20/11/2023

Briefcase study: Non-compliance with security requirement

The insured’s claim for the theft of his vehicle was rejected by the insurer on the basis that the insured did not comply with the security requirements stipulated by the policy. The insured vehicle was not fitted with a tracking device.

Read more on the interesting outcome of the case here:https://www.osti.co.za/media/1611/osti_briefcase_2nd_ed_2023.pdf

15/11/2023

Insurance fraud is a serious crime. Do not partake in it or be a victim of this crime. Here are some common types of insurance fraud:
• Staged accidents
• False claims
• Premium diversion
• Identity theft
If you suspect insurance fraud, report it to your insurance company immediately.

13/11/2023

In recognition of National Fraud Prevention week we are recommitting to helping consumers avoid insurance fraud with some insurance tips:
• Be wary of unsolicited phone calls or emails from people claiming to be from your insurance company.
• Never give out your personal or financial information to someone you don't trust.
• If you're unsure about the legitimacy of an offer, contact your insurance company directly.

09/11/2023

: Make sure your business and assets are adequately insured and protected. Commercial insurance can protect your business from a variety of risks, including:
• Property damage
• Liability claims
• Business interruption
• Employee theft
• Cyberattacks

08/11/2023

: Make Choosing the commercial insurance policy a priority this entrepreneurship month.
• Make sure the policy covers the risks that are most relevant to your business.
• Compare policies from different insurers to find the best deal.
• Read the policy carefully before you purchase it.

07/11/2023

In recognition of Entrepreneurship Month this November, we would like to remind entrepreneurs of the importance of short-term insurance. It is important to protect your business from unexpected events. Commercial insurance can protect your business from financial losses caused by property damage, liability claims, and other risks.

Here are some types of commercial insurance that entrepreneurs should consider:
• General liability insurance
• Property insurance
• Business interruption insurance
• Commercial auto insurance

31/10/2023

We encourage consumers to be proactive in recognising when their policies change and to become familiar with their policy terms to understand their scope of cover. When your insurance premiums increase, please contact your insurer to see if your coverage stays the same or if your policy has changed. Listen as Chief Executive Officer at the Ombudsman for Short-Term Insurance, Edite Teixeira-McKinon expands on the topic:

27/10/2023

The Ombudsman for Long-term Insurance wishes to alert policyholders to Policyholder Protection Rule 2A.6.5, which provides that when applying for a new funeral policy, an insurer may not impose a waiting period if the policyholder can show that he or she enjoyed cover for a similar risk under a funeral policy, and no more than 31 days had passed between the cancellation of the previous policy and applying for a new funeral policy. When a policy is cancelled, either by an insurer or a policyholder, we would strongly suggest that policyholders obtain certificates from their current insurers that set out the cover enjoyed, and the benefit amounts, when applying for new funeral policies with other insurers.

23/10/2023

: : When taking out a policy, always provide accurate and complete information to the insurer. This will enable the insurer to underwrite the risk properly and minimise issues that may arise at claim stage.

• Read your policy and the covering letter. The covering letter usually highlights key information from the policy such as inspection requirements, security requirements, the insured values, waiting periods, excesses, limits, towing and emergency assistance contact details, etc.
• Make sure that your property is insured for the correct value.
• Check your policy and speak to your insurer to find out which items require a valuation certificate.

19/10/2023

Assistant ombudsman, Nekecia van Niekerk shares vital information on OSTI's services and how they can help you.

See the video below for her full insights.

19/10/2023

Today we are out at Wolmaransstad for a Consumer Workshop. The workshop will focus on Moto vehicle insurance. Stay tuned for interesting highlights from the workshop.

18/10/2023

Briefcase study: Shuttle used to carry fare-paying passengers.

The insured claimed for accident damage to his motor vehicle. When the vehicle was placed on cover, it was insured for use as a shuttle service. During the validation of the claim, the insurer established that the vehicle was registered for use as a
taxi with a local taxi association. The insurer concluded that as the vehicle was used as a taxi to carry fare-paying passengers, this use fell outside the scope of cover. Read more on the outcome of this case:https://www.osti.co.za/media/1611/osti_briefcase_2nd_ed_2023.pdf

16/10/2023

ConsumerTipofTheDay: Make vehicle insurance a priority.

•Make sure you have the right coverage for your needs. Consider your driving habits, the type of car you drive, its usage, and where you live when choosing a policy.
•Review your policy regularly. Your needs may change over time, so it's important to make sure you have the right coverage.
•If you're involved in an accident, contact your insurance company as soon as possible to file a claim.

If you have any problems with your car insurance company over a claim, we can help.

We offer a free and confidential dispute resolution service. Just send your complaint to [email protected] or lodge your complaint online. If you need help, give us a call at 0860 726 890, and one of our friendly administrators will assist you.

11/10/2023

OSTI is also working to raise awareness about the importance of natural disaster coverage. We encourage consumers to review their short-term insurance policies and make sure they have the coverage they need to protect their property and belongings.
If you have any problem with your short-term insurance company over a natural disaster claim, OSTI can help. We offer a free and confidential dispute resolution service

09/10/2023

Your feedback matters to us. We are committed to providing the best possible service to our customers. That's why we value your feedback.

Email us your feedback today to: [email protected]

04/10/2023

Unpredictable weather conditions can cause significant damage to your property and belongings. Make sure your household and business assets are adequately insured. If you've been affected by a natural disaster, contact your short-term insurance company as soon as possible to file a claim.

02/10/2023

We are committed to providing a fair and impartial dispute resolution service for short-term insurance consumers. We are proud to have helped thousands of people resolve their complaints and get compensation.

If you have been unfairly treated send your complaint to [email protected] or lodge your complaint online. If you need help, give us a call at 0860 726 890, and one of our friendly administrators will assist you.

Address

1 Sturdee Avenue, First Floor, Block A, Rosebank
Johannesburg
2196

Opening Hours

Monday	08:00 - 16:30
Tuesday	08:00 - 16:30
Wednesday	08:00 - 16:30
Thursday	08:00 - 16:30
Friday	08:00 - 16:30

Telephone

+27860103236

Website

https://www.insuranceombudsman.co.za/

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Videos

Assistant ombudsman, Nekecia van Niekerk shares vital information on OSTI's services and how they can help you. See the video below for her full insights.

The Ombudsman’s office applies the principles of fair dealing and equity and even though there has been a breach of the policy condition, the Ombudsman’s office can compel an insurer to effect payment, depending on the circumstances. #shortterminsurance #consumerrights #consumerprotection

The Ombudsman for Short-Term Insurance is an independent organisation which applies the law together with fairness and equity in resolving disputes between consumers and short-term insurers. #shortterminsurance #consumerrights #consumerprotection

Join us for FREE online webinar today. We’ll be providing guidance on how good credit management today, can lead to better credit prospects. Register now to take control of your financial future! Register to join the webinar here: https://bit.ly/3svg0kC

The financial ombud schemes will assist any consumer in a language that they prefer. Register to join the webinar here: https://bit.ly/3svg0kC #MSWSA2023 #PlanYourMoney #PlantYourFuture #Ombudsman

Due to the increase in weather-related hazards such as floods, wildfires, storms and earthquakes. We would like to encourage consumers to plan ahead. While these disasters cannot be predicted, what you can do is be better prepared for unpredictable events. One of the most important steps can be taking proactive steps by setting up your insurance policy in a way that covers you from natural disasters. Listen as Assistant Ombudsman, Relebogile Mashego expands on this topic:

With load shedding predicted to stay, damage to personal property may become a new reality and its best that households be prepared. We have seen a significant increase in claims for damaged assets triggered by load shedding. Listen to Senior Ombudsman, Peter Nkhuna as he unpacks more on this topic:

Watch Senior Assistant ombudsman, Peter Nkhuna as he sits down with eNCAnews to offer some valuable advice on protecting your assets and belongings during power outages :

Watch as Senior Assistant Ombudsmen, Peter Nkhuna shares some valuable insights today on Understanding Short-term insurance and money management #MSWSA22 #PlayYourPart

Load shedding has led to a spike in insurance claims. We have seen a rise in claim rejections due to load shedding. Senior Assistant ombudsman, Peter Nkhuna sits down with eNCAnews to offer some valuable advice: Watch the below interview

OSTI’s Case Administrator, Mbalenhle Mdakane, offers important information to the youth. For tips and advice click here: #OSTIYouth2022

OSTI’s Complaints Registration Administrator, Lucky Jacobson discusses the importance of insurance for young people. Listen to the clip below to find out how you can save money: #OSTIYouth2022

OSTI’s Accounts Assistant, Comfort Sebalane discusses how the youth can mitigate risks. Listen to the clip below for more insights: #OSTIYouth2022

Are you still thinking about getting your first car? OSTI’s Legal Intern, Cute Mokoena has important advice for you. Listen to her valuable insight here: #OSTIYouth2022

OSTI’s Complaints Registration Administrator, Amukelani Maringa has an important message for the youth. Listen below for more information: #OSTIYouth2022

OSTI’s Legal intern, Msizi Zungu discusses the services offered by the office of the short-term insurance ombudsman. Listen to the clip below to hear his thoughts: #OSTIYouth2022