Secondary

Short-Term Ombud Annual Report

There can be little doubt that there is a steady increase in the efficiency of this champion for the fair treatment of consumers.

The figures listed below come directly from the Ombud’s report:

The total number of complaints received during the year was 9,368 which represent an increase of 245 or 2.7% over 2012. The number of complaints received during the period January to March 2014 shows a material increase compared to the similar period in 2013. Although it is too early to confidently conclude that this is indicative of a trend, early indications are that there will be additional pressure on the office during the rest of 2014.

The increase in the number of complaints may be attributable to several factors, including the number of claims registered due to adverse weather conditions and other factors, the effect of the Treating Customers Fairly campaign and, generally, the growing sophistication and awareness of consumers as to their contractual rights. Hopefully the service offered by this office may also have contributed to this trend.

The pace at which cases were resolved within six months, showed a healthy increase. The percentage increase in cases resolved is reflected as follows:

  • 2011 – 52%
  • 2012 – 63% and
  • 2013 – 87%

The number of matters unresolved after six months as at the end of December 2013 stood at 72 compared to 1319 in 2011 and 352 in 2012.

During 2013 approximately 113 formal claims meetings were held with insurers, apart from numerous one-on-one meetings with insurers and specific assistant Ombudsmen. These meetings continue to be a critical factor in the dispute resolution procedure. However, it is noticeable that the number of complaints dealt with at these meetings has reduced substantially in recent times. The reason for this is obvious, namely that there are fewer matters on the six month list to discuss. In fact the six month list is rapidly becoming obsolete and the focus is now on the five and four month lists.

Approximately 33% of the complaints to the Ombud led to the claims decision being overturned in favour of the client – this applies equally to personal lines and commercial business.

It appears that the Ombud has taken a firmer stance in recent times when interacting with product houses.

During the year reduced response times were imposed upon insurers which had the desired effect. As previously indicated, I have imposed a guideline rule that insurers should not be given more than two opportunities to present facts to this office in defence of their decision to repudiate a claim. Furthermore, insurers cannot explain away delays in responses to this office by referring to information which the insurer must first obtain from, for example, an underwriting manager.

This office looks to the insurer for a response and if the insurer chooses to use an underwriting manager, then the expectation of this office is that the insurer must manage the performance of its own underwriting manager.

Another pleasing aspect emanating from the report concerns liaison with various other bodies, including National Treasury and the FSB. There are also formal quarterly meetings with the SAIA/OSTI Liaison Committee, while consumer bodies are represented on the Board of the OSTI. The publication of the Ombudsman’s Handbook for use by insurers in their dealings with the office is yet another step in the right direction.

There can be little doubt that these open lines of communication played a big role in the improved delivery from the office of the Ombud.

We commented last week on the decision to intervene when an insurer elected to disregard the valuations provided in the Auto Digest. There were only two such cases in 2013, which indicates healthy cooperation between the industry and the Ombud in resolving matters in a fair manner.

In our view, fairness to all is a non-negotiable requirement as far as an adjudicator is concerned. In this regard, the Short-term Ombud must be commended for what it achieved in 2013.

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