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Please note: This brochure is available in English and Zulu
Alternatively you can also email us at [email protected] and we'll gladly post you a copy.
Please note: This brochure is available in English and Zulu
"The Ombudsman for Long-term (life) Insurance and the Ombudsman for Short-term (non-life) Insurance, together put almost R400-milion back in the hands of consumers who complained in the past financial year.
In a joint 2021 Annual Report, the Ombudsman for Long-term Insurance (OLTI) noted that R200 million was recovered for complainants while the Ombudsman for Short-term Insurance (OSTI) said the monetary benefit for consumers amounted to R197 188 388..."
OSTI's Service Charter reflects OSTI’s values and explains what a complainant and insurer can expect from the office during the registration and investigation of a complaint, and, in turn, what OSTI requires in order to register and investigate a complaint.
An increasing number of motor vehicle accident insurance claims are being rejected and disputed on the strength of a clause in insurance policies, namely the reasonable precautions clause, the Ombudsman for Short-Term Insurance (OSTI) has announced...
Honesty is the best insurance policy. Blatantly lying or omitting the truth when claiming puts you on a slippery slope. If you get caught committing insurance fraud, you not only could have a claim denied but could experience more extreme consequences...
Short-term insurance contracts operate on good faith and it is the insured’s responsibility to disclose all material facts that may reasonably be expected to enable the insurer to properly assess the risk...
The policy provided that insured valuables that are governed by the “close personal custody and control requirement”, in it means that the insured property shall be “held by, worn or attached to the insured at all times whilst in transit.”...
Please download the OSTI Press Release regarding the COVID-19 Pandemic below.
The insurance industry will have a single Ombudsman from 1 January 2020. He is retired Judge, Mr Justice Ron McLaren who brings with him a wealth of judicial experience and knowledge in dealing with and resolving insurance disputes.
Download the full press release below.
"...The report highlights a worrying trend in car insurance: an increasing pressure on you, the policyholder, to prevent loss or damage to your car by taking 'reasonable precautions'..."
Read the Eye Witness News article here: Majority of people haven't insured their household contents - Ombudsman (ewn.co.za)
"Always keeping your car in good nick and regularly serviced could well be to your advantage in the event that an insurer disputes a claim on the basis that the vehicle was in an unroadworthy state.
The Ombudsman for Short-Term Insurance recently ruled in favour of an insured who was able to produce proof that his vehicle had been serviced three days before it was in an accident.
In his Details of Complaint, the insured said his vehicle hit the rear side of a taxi that was stationary, had no hazard lights and no triangle to warn that it was stopped.
“Upon realising that the taxi was not moving, I tried to move to the next lane. An oncoming vehicle could not make way for me to overtake the taxi which then resulted in me hitting the rear side of the taxi,” said the insured.
The insurer had rejected the claim based on the assessor’s report which stated that the rear tyres were smooth, thereby rendering the vehicle unroadworthy.
The insurer said that the assessor had inspected the tyres and found that both rear tyres had excessive wear. The insurer pronounced the vehicle unroadworthy at the time of the accident and concluded that the poor condition of the tyres had directly contributed to the loss.
The insured said that the vehicle was taken for a service three days prior to the accident and the tyres were found to be in a roadworthy condition.
In the ruling, the Ombudsman said that the insurer had failed to prove that the unroadworthy tyres had caused the accident and recommended to the insurer that it settle the claim on the grounds that, as the insurer was relying on an exclusion, it had to prove on a balance of probabilities that the condition of the tyres was material to the cause of the accident, which it had failed to do.
“The insurer had not demonstrated that, if the insured had braked and the tyres were in a good condition, then the insured would have been able to avoid the accident,” said Senior Assistant Ombudsman, Darpana Harkison.
The Ombudsman considered the insurer’s findings and noted that the findings did not relate specifically to the circumstances of the insured’s accident in that they were based on generalised conclusions drawn by other experts based on other specific sets of circumstances. The insurer’s expert did not take into account the fact that the insured had been faced with and reacted to a sudden emergency.
Referring to the clause that the insurer relied on to reject the claim, the Ombudsman said: “This clause requires that the insured take steps to maintain the vehicle and considering that the vehicle was taken in for a service three days prior to the accident, this rejection reason cannot be upheld.
“In our view the insurer’s failure to prove that the unroadworthy tyres were the cause of the accident leads to the inevitable conclusion that it failed to discharge its onus of proof in relation to the exclusion being relied on in substantiation of its rejection of the claim.”
The insurer abided by the ruling and settled the claim."
Maintaining a vehicle can save a claim from being rejected (fanews.co.za)
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Chief Executive Officer of the Ombudsman for Short-Term Insurance, Edite Teixeira-McKinon, and the Director of Kapara Insurance Brokers, Morag Dover, join Bryan Hirsch in studio to discuss the insurance industry including power surge claims due to load shedding.
WATCH: The insurance industry and power surge claims due to load shedding: Part 1 - YouTube
The Ombudsman for Short-term Insurance discusses the recent flood damage to homes in KZN and homeowner’s insurance in general. Why claims may be declined and what consumers could do to avoid problems when claiming. View the interview here Yilungelo Lakho | 03 May 2022 - YouTube
View the ENCA interview here: KZN Floods | Unpacking insurance policy covers - Banoyi.com
A consumer workshop, addressing trending complaints, hosted by the Ombudsman for Short-Term Insurance (OSTI) featuring guest speakers from the Office of the Ombud for Financial Services Providers (FAIS), the Motor Industry Ombudsman of South Africa (MIOSA), the Ombudsman for Long-Term Insurance, The Credit Ombud, The Consumer Goods and Services Ombud (CGSO) and the Johannesburg Ombudsman.
The offices of the Ombudsman for Short-term Insurance (OSTI) and Long-term Insurance (OLTI) hosted a joint Consumer Workshop on 26 August 2021. The panel discussed:
For further information, please email [email protected] (Short-term Insurance) or [email protected] (Long-term Insurance). Media enquiries may be emailed to [email protected]
A training workshop presented by Senior Assistant Ombudsman, Mr. Peter Nkhuna, for the Insurance Institute of South Africa (IISA) on 28 July 2021 regarding OSTI's investigation and decision making process, particularly the application of fairness and equity.
The Ombudsman for Long-term Insurance (OLTI) and the Ombudsman for Short-Term Insurance (OSTI) recently had what it calls a “soft amalgamation” and have collaborated under the banner of “The Insurance Ombudsman” to bring you this production, which covers hints on funeral policies, credit life insurance, and case studies on motor insurance and business interruption cover. The production explains who or what is the ombudsman, what it does, and how it is done. It also reveals the ombudsman in action.
The Ombudsman for Long-term Insurance (OLTI) and the Ombudsman for Short-Term Insurance (OSTI) recently had what it calls a “soft amalgamation” and have collaborated under the banner of “The Insurance Ombudsman” to bring you this production, which covers hints on funeral policies, credit life insurance, and case studies on motor insurance and business interruption cover. The production explains who or what is the ombudsman, what it does, and how it is done. It also reveals the ombudsman in action.
"When times are hard and consumers find themselves in a tight financial situation, and they are forced to cut down, research shows that the first things consumers cut, to free up funds, is insurance. But is it a clever move?"
Download the interview below.
Download the interview below.
Each matter is dealt with on its own merits and no precedent is created by the findings in these matters. The case-studies are intended to provide guidance and insight into the manner in which this office deals with complaints.
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