It is not compulsory for you to complain first to your insurance company before submitting a complaint to OSTI. This means that OSTI will consider your complaint even if you have not yet complained to your insurer. However, we do suggest that, before submitting a complaint to OSTI you first try to resolve your issue with your insurer. We give this advice because –

  • It is helpful if the insurer has the chance to look into any complaint, before the ombudsman steps in so that it can make sure it has made the right decision.
  • Many complaints are caused by a misunderstanding, either on your part or on the part of your insurer. These types of complaints can be quickly and easily fixed once the problem is understood.
  • When you complain to the insurer, your claim will usually be looked at by a different person at the insurer. This means that you will get a second opinion from the insurer and you may have your issue resolved.
  • Even if your issue is not resolved by the insurer, submitting a complaint to the insurer may give you more information about your matter which will assist you in making your complaint to OSTI.

  

  1. It is usually best to complain in writing. But if you phone, ask for the name of the person you speak to. Keep a note of this information, with details such as, the date and time of your call and what was said. This may be required at a later stage.
  2. Remain calm and polite, however emotional, angry or upset you may be. You are more likely to explain your complaint clearly and effectively if you can stay calm.
  3. Initially attempt contacting the person you originally dealt with. If they cannot help, indicate that the matter will be taken further. Seek details of the name or job title of the person who will be handling your complaint and for details of the Insurer's complaints procedure.
  4. Attempt taking up the matter with a senior official at the insurer.
  5. When you write a letter of complaint, set out the facts as clearly as possible.
  6. Write down the facts in a logical order and stick to what is relevant. Include important details like your claim number or your policy number.
  7. Keep a copy of any letters between you and the Insurer.

  

What to do next:

If you are not happy with the Insurer's decision you may:

    

  1. Contact us. We may be able to help. You will need to fill in our complaint form and send it back to us.
  2. Issue a summons against the insurance company out of the Small Claims Court (there is a small cost involved). The maximum amount that can be claimed in the Small Claims Court is R 15,000.00.
  3. Consult with an attorney to pursue the matter by means of further legal action.

You complain by filling in an application for assistance form and sending it back to us. You can either do this online or by downloading our application form. You can send the filled in application form to:

 

E-mail: info@osti.co.za 

Fax: 011 726 5501

PO Box: 32334, Braamfontein, 2017

 

If you need our help with filling out the form you can contact us at 011 726 8900 / 0860 726 890 and we will gladly help you to fill out the form. Or, you are welcome to come in and see us at 1 Sturdee Avenue, First Floor, Block A, Rosebank, and we will help you complete the application form.  CLICK HERE for directions.

We have trained staff able to assist you in filling out the application form in the following languages: Afrikaans, Xhosa, Zulu, Southern Sotho, Northern Sotho, Tswana, Ndebele, SiSwati and English.

Our operating hours are from Monday to Friday at 8am to 4:30pm.

No, OSTI's services are free to consumers.

No, all we need from you are the documents that are relevant to your side of the story and any other information that you may have that will help us to deal with your complaint. We decide if the insurer has handled your matter properly by looking at the facts of the case – not at how well you present your arguments. We prefer to hear from you in your own words. Our services are free and informal and we are not a court.

That does not mean you do not have the right to use someone else’s services to act on your behalf. Some people use friends, relatives, lawyers or brokers to help them with their complaints. If you do use someone else to help you, you will need to fill in a power of attorney and send this to us. If you do decide to appoint a specialist or an attorney you will have to pay their costs yourself. There is no difference in the outcome of complaints - whether you do it on your own or pay someone to do it for you.

Although the insurer pays a fee for each complaint that is submitted to OSTI, OSTI understands that insurers get their funding from consumers who pay their premiums. We therefore appreciate at all times that our services are funded both by the consumer and by the insurer. In any event, OSTI takes its role as an impartial and independent forum very seriously and deals with each complaint that is lodged with it in this way.

Whether we can help with your own complaint will depend on:

  • Whether the insurer you are complaining about is a member of OSTI;
  • Whether OSTI can deal with the type of insurance cover that you are complaining about. OSTI can only deal with certain types of short-term insurance complaints.
  • When the event you are complaining about took place. Time limits apply if you leave it too late to complain.
  • Whether you have already taken legal advice or issued a summons or been to court. We cannot help you if you have already sought legal assistance elsewhere (except if that assistance is to help to lodge a complaint with us).
  • Whether the factual disputes between you and the insurer are not able to be decided from the documents and information that has been given to us. In these circumstances we will have to close our file and you will have to take your matter to court or arbitration.

If you're not sure if your complaint is one we can help with, just ask us.

OSTI has jurisdiction to deal with any short-term insurance matter where –

  • The insurer is a member of OSTI;
  • The claim is within its monetary jurisdiction.

UNLESS

  • The complaint is already being handled by an attorney, except where the attorney is helping you to lodge a complaint to OSTI;
  • The subject-matter of the complaint is already part of litigation in court or arbitration;
  • The complaint is about one of the following types of insurance cover:
    • Accounts receivable
    • Aviation
    • Construction guarantees
    • Crop insurance (including stock put through cover)
    • Deterioration of stock
    • Engineering
    • Fidelity claims
    • Loss of profits
    • Machinery breakdown
    • Marine
    • Third party, computer and funds transfer theft
    • Third party claims (except for third party claims where the policyholder has not been indemnified) including but not limited to –
      • Motor third party liability;
      • Contractor’s liability;
      • Directors’ and officers’ liability;
      • Employer’s liability;
      • Employment practises liability;
      • Public liability.

 

If you're not sure if your complaint is one we can help with, just ask us.

Yes we can but please note that in order to liaise with your insurer we will handle your complaint in English.

Call us and tell us what language you speak and we will try to provide someone to assist you in filling out your application form and understanding the process.

We have trained staff able to assist you in filling out the application form in the following languages: Afrikaans, Xhosa, Zulu, Southern Sotho, Northern Sotho, Tswana, Ndebele, SiSwati and English.

We look at each complaint carefully. There is no set time in which we resolve complaints. Each matter is different and how long it takes will depend on a number of things including:

  • How complex the complaint is;
  • How long it takes to get all the relevant information and for both sides to tell their story;
  • Whether reports from third parties (such as loss adjusters or claims experts) are needed;
  • Whether you or the insurer accept our initial recommendation.

Some complaints can be resolved in a few weeks. About 50% of complaints submitted to OSTI are resolved within four months. Only 3% of complaints take longer than nine months to resolve.

We publish detailed figures showing how long it takes us to resolve complaints each year in our annual report.  

Once we receive your application for assistance we will consider it to make sure –

  • It contains all the relevant information;
  • Your complaint falls within our jurisdiction.

Once satisfied we will allocate a reference number to you. PLEASE MAKE SURE YOU USE THIS REFERENCE NUMBER WHENEVER YOU COMMUNICATE WITH US.

Once your complaint has been registered we will send it to the insurer. The insurer will be given 14 days from the date that it receives your complaint from us to try to resolve the matter with you.

If the matter is not resolved to your satisfaction during this period, the insurer will then submit a formal answer to us stating why it does not agree with your complaint.

We will send this response to you and we will either give you our initial view on the outcome of the matter or, if we still need more information, simply ask you to give us your response to the insurer’s answer to your complaint.

At this stage there is often a delay as we may need time to consider the information that has been given to us and we may also need to ask for more information.

Once we have all the information we need we may:

  • Make a recommendation suggesting the outcome of the complaint;
  • Decide that there are too many factual disputes to be resolved and that we are not able to help you any further.

We look at the individual circumstances of each case. Our recommendations are based on the law and, where appropriate, on what we believe is fair and reasonable. When deciding a complaint we consider all the relevant facts and arguments. The outcome will be based on the version of events that seems the more likely or probable. This is called deciding on a “balance of probability” and refers to the standard test to be used when deciding civil (as opposed to criminal) disputes.

We will always ask both you and the insurer for your views. We will also give each side a chance to comment on what the other side has said. If we need specific information from you or the insurer in order to assist us in deciding the case we will ask for it. Only once we have gathered all the necessary information will we make a decision. We do not have the power to hold hearings or allow witnesses to testify. All of the information must be provided to us electronically or in writing.

A decision is binding on the insurer and the insurer cannot withdraw from our complaints process unless you choose to do so.

OSTI is independent and impartial. This means that it is neither a consumer champion nor an industry trade-body. If we believe that the insurer has made a mistake, or that your issue was unfairly handled by the insurer, we will say so. If, however, we do not find fault with the way in which the insurer has dealt with your matter, we will find in favour of the insurer. Our approach to a matter is much the same as that of a judge in court – we consider the facts of your matter and make a decision based on the law and, where appropriate, on considerations of fairness and equity.

OSTI is completely impartial. Although we do not report the outcomes of individual complaints we are open and transparent about the general nature of the work that we do. Each year we publish an annual report which sets out a wide range of data relating to the complaints that were referred to us in that year, including data about the number of complaints that were decided in favour of the consumer. Click here for our annual reports.

No. OSTI’s purpose is to deal with individual complaints between insurers and consumers and to put things right where there has been an error or mistake. This may mean that we tell an insurer to pay a claim or remove an excess fee or amount that has been charged to the consumer. But we do not make rules for insurers or impose fines or punishments if we believe they have done something wrong. We do not monitor the way they do business or make sure that they are complying with the law. That is a job for the Regulator (The Financial Sector Conduct Authority).

No, OSTI can only deal with issues on a complaint by complaint basis. Each complaint must be individually assessed on its own merits. However, if an issue arises that might have a large impact on other consumers or on the insurance industry, OSTI will discuss this with the Regulator. The Regulator will then decide on the best way to deal with the issue.

If you are unhappy with the recommendation that is made, you may ask for it to be “escalated” to a senior assistant ombudsman for review. A matter will not be suitable for review simply because you are unhappy with the result and wish that it had been decided in your favour. Instead your reason for asking for a review should be because you believe that OSTI made the wrong decision and that someone else considering your matter may make a different decision.

If you are not happy with OSTI’s decision, your rights are not at all affected. You are not bound by our decisions. You are still free to look for other ways to continue to challenge the insurer’s decision. You can see a lawyer, go to court or pursue other forms of dispute resolution such as arbitration.

If you are unhappy with the way OSTI has treated you please let us know. For example, if you think we have:

  • treated you unfairly or rudely;
  • failed to explain things properly; or
  • caused unreasonable delays.

Please note that a service related complaint does not relate to the outcome of a complaint but instead to the way OSTI has handled a complaint.

If you wish to complain about the service that you received, please download and complete the applicable customer experience survey below:

OSTI will usually, but not always, provide both sides with all of the information given to it. There may be some instances where a party asks OSTI to keep certain information confidential. This could be because the information is, for example, –

  • A legal opinion obtained for the purposes of litigation;
  • A confidential investigation report dealing with wider issues than the complaint – for example, an investigation into fraudulent conduct;
  • Revealing the information may place a person at risk.

If you believe that information should be kept confidential between you and us, you must mark that information clearly and tell us why you think we should not pass it to the other side. We will consider your request - but we may not agree to it, unless there is a strong case for confidentiality, such as security reasons.

We may publish case studies and information about complaints but we do not release the names of the individual consumers involved.

Sometimes, if it is appropriate to do so, we will exchange information with the Regulator.

OSTI receives around 15 000 complaints each year and investigates around 10 000 of those. If OSTI was required to hold a hearing in respect of even half of these matters it would be unable to provide the assistance to complainants and the industry that it currently does. Instead OSTI provides an informal alternative to civil court. We cannot compel witnesses to attend hearings and give evidence.

We also do not have the power to compel witnesses to take an oath or affirmation or to subject themselves to cross examination. Our process is entirely different from that of a court where two lawyers will argue a matter and present evidence to a judge who will then make a decision. Instead, OSTI will act in an inquisitorial manner and will ask questions and for information. OSTI is not restricted to the issues set out in the complaint.

It can go further if necessary and request additional information. OSTI is required by law to resolve matters fairly. This means that it can decide how a matter should proceed and ask questions to ensure that it gets to the bottom of the issue. This means that we are not persuaded by the best legal argument but instead focus on the actual facts of the complaint.

We try to achieve an informal resolution of the matter as soon as it is possible. In many instances we are able to resolve matters to the satisfaction of both sides by making informal recommendations and without having to issue formal ombudsman decisions.

We are an alternative to the court system. Our aim is to resolve disputes as quickly, cost-effectively and informally as we can. Hearings are expensive and time-consuming and for this reason we do not hold hearings as part of our process. If you want “your day in court” then our office is the wrong forum for you and you should seek the assistance of a lawyer. If your matter involves complex factual disputes that will not be capable of being resolved on the papers, then you are also in the wrong forum and should seek the advice of a lawyer or approach the small claims court.

OSTI is answerable to its board of directors. The chairman and board directors are "non-executive". This means that they are not involved in considering individual complaints. Instead they are concerned with issues relating to the governance of OSTI.

They ensure that OSTI is properly resourced and able to carry out its functions effectively, impartially and independently – free from any control or influence by those whose disputes we resolve.

Insurers enter into a contractual agreement with OSTI promising to abide by OSTI’s rulings. You can read more about this in our terms of reference.

Yes you can appeal against a decision by the ombudsman but only if the ombudsman has made a formal ruling against you and granted you leave to appeal against that ruling.

For more information on appeals see OSTI’s terms of reference.