In a perfect world you’d never suffer any losses and never need household insurance. Of course, insurance to protect your home’s valuable contents is sold because we don’t live in that fantasy land. In a less perfect world, but still a nice one, even if you have suffered a property loss, your insurance company would gladly open its wallet and pay you whatever you think you deserve.
The reality is that even the most well intentioned, consumer oriented insurer needs to be careful with claims and the making of payouts. They can’t realistically just pay everyone who sticks out their hand without taking a hard look at the specifics of the case, the exact terms of the contract, and any evidence substantiating the claim. This is especially true due to many false claims that have been filed or “semi-truthful” claims (claims that arise from actual events but have been inflated) that have made the insurance companies more cautious. This need to carefully check each claim can result in disagreements between consumers and insurers whether certain claims should be paid.
What can you do if your claim has been rejected by your insurance company?
Fortunately, in South Africa you can turn to The Office of the Ombudsman for Short-Term Insurance. The Ombudsman, first set up in 1989, can assist consumers in dealing with home insurance claims disputes in a fair manner and can be very helpful seeing how the insurance companies have agreed to abide by the Ombudsman’s decision. It’s important to realize that the Ombudsman does not take the consumers side and does not provide legal advice. The Office simply acts as a free, impartial arbitrator to resolve consumer vs. insurer disputes, including claims related to household insurance.
How to file a complaint with the household insurance Ombudsman
1) Prior to contacting the Ombudsman you are required to first try and resolve the issue with your insurer. Only once you’ve done this should you contact the Ombudsman. The Office of the Ombudsman has a formal claims procedure, so you can’t just call them and you’ll need to submit the relevant forms in writing.
2) Consider why the insurer rejected your claim. Do you really have a valid claim against them, or are you just thinking of “trying your luck” by involving the Ombudsman? Do you see any language in the policy agreement terms that supports your claim? If so, you’re ready for the next step:
3) Download and complete a complaint form from the Office of the Ombudsman for Short-Term Insurance and post it to the address listed in the form. They also accept completed forms by fax to (011) 726-5501. Another option is to email the form to firstname.lastname@example.org. We personally think it is best to use at least 2 of the above sending methods.
4) Have these documents handy:
a. Legible Copy of Identity Document or Passport
b. Letter from Insurer rejecting the claim
c. Policy Schedule / Certificate of Insurance
d. All documentation, including correspondence with the Insurer relevant to the complaint
Tip: Remember to keep copies of your complaint in case they get lost or in case you need to send them to someone else. Also, only send copies of documents to the Ombudsman and not the originals.
5) More details on the complaint process are available at http://osti.co.za/steps-to-lodge-complaint.html.
Do I have any other legal options?
Turning to the Ombudsman is a no risk, no cost, option for you. Your Insurer must accept the Ombudsman’s decision should he decide in your favor. You, on the other hand, are under no such obligation. If you are not satisfied with the arbiter’s decision, you retain the full right to file a legal claim against the insurer. Specifically, the you may choose to issue a summons out of the Small Claims Court against your Insurance Company. There is a small fee for doing this. You should note that the Small Claims Court only deals with cases up to the value of R7,000.00 – but that should certainly be enough in most cases.
Additionally, an attorney could be hired to discuss the feasibility of pursuing other legal avenues.
Content insurance (also known as household insurance) will protect you against losses due to theft, fire, and other causes. But, just in case your insurance company refuses to pay and you’ve exhausted all avenues of direct negotiation, you can definitely take advantage of the professionals of The Office of the Ombudsman for Short-Term Insurance. If you follow their procedures and our tips in this article, your complaint may result positively.
Additionally, and perhaps more importantly, if you choose the right insurance company to start with, you shouldn’t have to deal with this. If you are reading this article, then maybe it is time to change your insurance company.
1. Click here to read our survey on “The Best Insurance company in South Africa for 2013”
2. Read a few Insurance Company Reviews about other insurance companies that might interest you.
3. Fill in the below form and a professional agent will get back to you with a Free household insurance quote.
Main subject: how to file a complaint with the household insurance Ombudsman