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Tag Archives | Ombudsman for Short-Term Insurance

claim-form

Business interruption-related complaints account for nearly half of Osti settlements

Only 259 of the new complaints registered by the Ombudsman for Short-term Insurance (Osti) last year were related to Covid-19. But settlements in Covid-related business interruption (BI) complaints accounted for 49.5% of the R197 million of what the Osti called the “monetary benefit and value” for consumers who approached the office for assistance. The percentage […]

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reckless-driving

Osti flags increase in disputes due to ‘reasonable precaution’ clause

The Ombudsman for Short-term Insurance (Osti) has once again flagged the increase in the number of complaints from consumers whose claims are rejected because insurers allege the driver failed to exercise reasonable precaution or due care. The number of these complaints increased by 48% in 2019 and 2020, and last year the Osti considered 26% […]

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jacuzzi-pump

Expert’s findings unreliable in dispute over damaged pump

The Ombudsman for Short-term Insurance (Osti) ruled that an expert’s findings on which the insurer relied to reject a claim were unreliable. The policyholder submitted a claim for storm damage to his jacuzzi’s pump. His claim was supported by a report from a contractor stating it had detected water damage, possibly from the heavy rain, […]

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tyre-burst

Policyholder triumphs over insurer’s tyre expert in tussle over vehicle claim

The Ombudsman for Short-term Insurance (Osti) found that the conclusions drawn by a tyre specialist could not be relied on to decline a policyholder’s claim. The insurer used the specialist’s findings to support its view that the insured’s vehicle was unroadworthy when it collided with a wall. The policy excluded cover when the car was […]

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The onus of proving driving under the influence of alcohol

I commented last week on the difficulty experienced by insurers to obtain irrefutable proof where there are suspicions that someone involved in an accident may have been driving under the influence of alcohol (DUI). An article in the Ombudsman’s Briefcase provides insight into how the Ombudsman for Short-term Insurance approaches such cases. Most vehicle insurance […]

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vehicle-accident

Insurers making increasing use of ‘reckless driving’ clause to reject claims

Insurers are disputing or rejecting an increasing number of motor vehicle accident claims on the grounds that the insured was speeding, and consumers should be made aware of the implications of the reasonable precautions clause in their policies, the Ombudsman for Short-term Insurance (Osti) says. The clause requires that the insured must use all reasonable […]

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telematics

Will loyalty programme devices be used to refute claims?

My colleague Mark Bechard’s article on the increase in rejected claims because of reckless driving raises a few interesting questions about the possible use of technology when investigating such claims. The Ombudsman for Short-term Insurance (Osti) quotes two case studies. In the first, the insurer was ordered to pay a claim after the Osti found that […]

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Expired drivers licence shouldnt automatically result in claim rejection

Expired driver’s licence ‘shouldn’t automatically result in claim rejection’

Insurers that belong to the SA Insurance Association (SAIA) should not reject claims solely because a driver’s licence has expired. SAIA was responding to a question about the implications for drivers who are involved in an accident without a valid driving licence card because of the backlog in issuing cards. The Department of Transport said […]

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