How useless is the short term insurance ombudsman

Item: Ombudsman for Short Term Insurance
Rating: 1
Author: Nathi Mkololo-Ndabambi

If ever there was a half a star they would have got it.

After PMD didn't want to honour my claim, I escalated my case with them under the two reasons.

1. PMD refused to pay claiming that I was drunk 2. Claiming that I was dishonest when completing claim for as I had indicated that I had not taken alcohol 3. That I was arrested and charged with DUI

My reasons to take the claim with them was on the following points.

1. On the AR, nowhere it has mentioned I was drunk.

2. As much as I was arrested, since there was nowhere it says I was drunk, under what reasons was I arrested for since the AR said it was an accident

3. The case was withdrawn and was never even asked to plead in court

4. I believe when someone is arrested for DUI, after the breathalyzer, he or she is immediately taken to hospital for blood samples.

After stating all these, they told me they uphold the decision by the insurer and should I wish to go forward with the matter I can go for litigation.

That's when I remember that the ombudsman get the funding from the insurer therefore it would make no sense to rule against the people who fund you.

At least they should have given me the reason to uphold the decision than sending it further knowing exactly that I don't have the financial muscles to fight this.

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Replies (1)

Ombudsman for Short Term Insurance's replyOfficial

15 May 2020, 09:46

Dear Nathi Mkololo-Ndabambi

You have not provided your OSTI file reference number. As s such, I am not in a position to respond to the direct merits of your complaint. I will, however, point out the general legal principles relating to DUI rejections under your Short-term insurance contract.

This office will make a finding after taking all the facts of the claim into account. The insurance contract falls under the ambit of civil law, not ******** law, where more stringent rules apply. In considering whether or not the incident driver drove the insured vehicle whilst under the influence of alcohol, and in breach of the terms and conditions of the insurance policy is an issue decided on a balance of probabilities (as opposed to beyond reasonable doubt). The Ombudsman will decide on this issue based on all the available facts and information submitted by the insurer (circumstantial evidence), despite the incident driver having not been tested for alcohol by way of a blood test and convicted of a ******** offence in relation to the incident.

Yours faithfully,

Ayanda Mazwi
Senior Assistant Ombudsman.

Ombudsman for Short Term Insurance's reply15 May 2020, 09:46

Official

Yours faithfully,

Ayanda Mazwi
Senior Assistant Ombudsman.