The powers and authority of the Short-Term Insurance Ombudsman have been beefed up to better assist you with problems you encounter with your short-term insurer.
Importantly, the ombudsman's office is now completely independent of the short-term insurance industry. In the past, the appointment of the ombudsman was in the hands of the industry, but as of the beginning of this year the newly-formed Ombudsman's Council appoints all new ombudsmen. The new council comprises representatives of consumer bodies, the press, government and short-term insurance industry.
Another major step forward for consumers is that the ombudsman now has the power to make recommendations which are binding on insurance companies and on all brokers who are members of the Short-Term Insurance Association. These recommendations can be based on law, but can also take into consideration equity, fairness and proper insurance practice.
The aim of the Ombudsman is to provide a free, accessible, informal and speedy resolution process to consumers who have disputes with their insurers or intermediaries.
The Ombudsman can deal with a problem you have with an insurer or intermediary:
* Concerning the provision of insurance services; and
* The repudiation or partial repudiation of any claims.
The Ombudsman's services differs from the assistance you would get from a professional legal adviser. His or her role is confined to resolving your complaint, either by agreement between you and the broker or insurer responsible for your problem, or, the Ombudsman can make a formal or informal recommendation.
Where a material fact cannot be established, the Ombudsman may decline from dealing with your complaint and may recommend that you go to court with your problem.
Rulings made by the Ombudsman are binding on insurers and intermediaries.
Any time limit or lapse clauses in your insurance policy will be deferred while your dispute is being handled by the Ombudsman.
If you withdraw your complaint or if the Ombudsman finds that your complaint falls outside his jurisdiction, you have 30 days, or the remainder of the time limit provision in your policy, in which to institute legal proceedings against the insurer or intermediary.
You cannot take your complaint to the ombudsman if:
* Your complaint is the subject of litigation. If you lodge a complaint with the Ombudsman's office and then take the dispute to an attorney, the Ombudsman will withdraw from your case. You do, however, have the right at any time you wish to take your complaint away from the Ombudsman's office and resort to litigation;
* Your claim is more than R500 000, except where the insurer or intermediary agrees in writing to this limit being exceeded;
* You have not first tried to resolve your dispute with the insurer or intermediary;
* Your complaint is frivolous, vexatious, offensive or threatening;
* Your dispute is already being adjudicated under the Financial Advisory and Intermediary Services Act;
* If your complaint has already lapsed under any time limit clauses in your policy document; or
* If the incident you are complaining about took place more than two years prior to lodging the complaint with the Ombudsman's office (under special circumstances, this may be extended to a period of four years).
Telephone: (011) 726 8900; Fax: (011) 726 5501
Postal address: PO Box 30619, Braamfontein, 2017
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