Consumers get R119m for insurance complaints

Johannesburg - The Ombudsman for Short-Term insurance resolved claims worth R119m in favour of consumers during 2013, compared to R114m in 2012.

According to the Ombudsman's latest annual report, 9 368 complaints were received last year, an increase of 245 or 2.7% over 2012.

A constant 3 out of 1 000 claims filed with insurers ended up as complaints to the Ombudsman.

Of the total complaints 4 542 (48.5%) involved rejected motor insurance claims, while (1 934) 20.% related to houseowners' insurance. Only 5% (468) were commercial.

"The increase in the number of complaints may be because there was an increase in claims registered due to bad weather conditions over the past year and the growing awareness of consumers of their contractual rights," said Ombudsman, Dennis Jooste.

"The effect of the Financial Services Board's Treating Customers Fairly campaign may also have started to have an effect, with consumers becoming more educated about customer service issues."

Jooste said thanks to the professional staff at the office and the high level of co-operation from insurers, 87% of cases were resolved within six months in 2013, up from 63% in 2012.

The average days taken to resolve a complaint reduced from 183 days in 2012 to 111 days in 2013. The number of matters unresolved after six months as at the end of December 2013 stood at only 72 compared to 1319 in 2011 and 352 in 2012.

"Initially insurers were hesitant and undertook only to give 'serious consideration' to a recommendation by the Ombudsman," he said.

"Now insurers are contractually bound to honour any rulings made by the Ombudsman. These additional powers have been used responsibly, which shows in the fact that a final ruling has never been ignored by an insurer. Nor has there been an application to court to review a final ruling of an Ombudsman."

The average turnover rate for the year was 33%, which means only 1 out of 3 decisions made by an insurer was overturned. This is more or less in line with prior years.

Another major development during the year was the introduction of an appeal mechanism.

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