1 reviews | Active since Jun 2018
Didn't get any help from Ombudsman for Short term insurance
I am not sure if the ombudsman for short term insurance ever helps anyone, it took Kgomotso Molepo(Junior Ombudsman) three months to reply to me and tell me that he agrees with the insurer Absa idirect, after absa repudiated my vehicle accident claim for not disclosing a previous windscreen claim, throughout the process the was no communication whatsoever I asked a lot of questions that were never answered I am left confused with the findings of the ombudsman. When doing my own research I found out that insurance companies cannot repudiate claims for non-disclosure of minor claims
Just a few questions to the ombudsman
1. Is it the ombudsman’s position that insurers can repudiate for minor claims? 2. Did the insurer prove to the ombudsman that the claim was material 3. Kgomotso Molepo being an ex-employee of absa idirect doesn’t that compromise his rationality and objectivity?
I am merely using this platform to pose this because I couldn’t get helped posing this questions directly to OSTI
Thanks, ***/18B
Dear Mr. Mhlongo
It is not true that insurance companies cannot reject claims for non-disclosure of "minor claims". Short-term insurance contracts are entered into on the basis of good faith and it is your responsibility to disclose all material facts that may be reasonably expected of you to enable the insurer to properly assess the risk. Having regard to the underwriting questions posed to you at sales stage, it is warranted to conclude that all your previous vehicle claims were material to the underwriting of your policy.
You disclosed two previous claims during the sales call, after which the consultant specifically stated “if there were indeed 3 or more vehicle claims in the past 3 years and this is not disclosed to us this will affect our acceptability of the policy as well as any future claims.”
This office does not have jurisdiction over the insurer’s underwriting criteria, we therefore cannot decide on whether its consideration of windscreen claims in its underwriting guidelines is fair. These decisions are within the exclusive domain of the insurer and will differ from one insurer to another. We are however satisfied that the insurer comp**** with the terms of the Policyholder Protection Rules insofar as it posed a clear question to you relating to its underwriting criteria.
You submitted two windscreen claims under your comprehensive motor vehicle policies. Whilst you may have considered these to be minor incidents, the insurer did not ask if you had any major vehicle accident claims. It asked you to disclose all of your "vehicle claims". This included the windscreen claims. In the same conversation, the consultant asked you to disclose “any claims, losses or damages”, at which point you were again obliged to disclose the windscreen claims. According to its underwriting guidelines, this insurer would not accept a risk on cover where the insured had three or more vehicle claims in his insurance history. It established therefore that it was prejudiced by the non-disclosure. There is unfortunately no basis on which this office can justify a decision in your favour.
The ombudsman takes its role as an impartial and independent forum very seriously and deals with each complaint that is lodged with it in this way. Mr. Molepo's previous employment played no role in the decision taken on this matter.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman
Dear Mr. Mhlongo
It is not true that insurance companies cannot reject claims for non-disclosure of "minor claims". Short-term insurance contracts are entered into on the basis of good faith and it is your responsibility to disclose all material facts that may be reasonably expected of you to enable the insurer to properly assess the risk. Having regard to the underwriting questions posed to you at sales stage, it is warranted to conclude that all your previous vehicle claims were material to the underwriting of your policy.
You disclosed two previous claims during the sales call, after which the consultant specifically stated “if there were indeed 3 or more vehicle claims in the past 3 years and this is not disclosed to us this will affect our acceptability of the policy as well as any future claims.”
This office does not have jurisdiction over the insurer’s underwriting criteria, we therefore cannot decide on whether its consideration of windscreen claims in its underwriting guidelines is fair. These decisions are within the exclusive domain of the insurer and will differ from one insurer to another. We are however satisfied that the insurer comp**** with the terms of the Policyholder Protection Rules insofar as it posed a clear question to you relating to its underwriting criteria.
You submitted two windscreen claims under your comprehensive motor vehicle policies. Whilst you may have considered these to be minor incidents, the insurer did not ask if you had any major vehicle accident claims. It asked you to disclose all of your "vehicle claims". This included the windscreen claims. In the same conversation, the consultant asked you to disclose “any claims, losses or damages”, at which point you were again obliged to disclose the windscreen claims. According to its underwriting guidelines, this insurer would not accept a risk on cover where the insured had three or more vehicle claims in his insurance history. It established therefore that it was prejudiced by the non-disclosure. There is unfortunately no basis on which this office can justify a decision in your favour.
The ombudsman takes its role as an impartial and independent forum very seriously and deals with each complaint that is lodged with it in this way. Mr. Molepo's previous employment played no role in the decision taken on this matter.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman