Incompetence of Ombudsman for short - term insurance - Failed organization

Re: T195/22 Santam Insurance took 5 months to settle my car insurance claim for a not-at-fault accident that had taken place in November 2021. The entire claim was handled extremely poorly by Santam Insurance, whom I have spent decades with as a loyal customer without a car insurance claim. Furthermore, the repair company appointed by Santam to repair my vehicle performed terrible work on my vehicle and even went as far as to put inappropriate parts on the vehicle. After months of back and forth with Sanlam insurance on the work being performed by the repairer (during which time I was essentially without a vehicle), they eventually decided to write my vehicle off and pay me the payout amount. However, the entire time I was waiting for Santam to settle my claim, either by repairing my vehicle correctly or settling the claim in its entirety, I still had a substantial car payment to pay for a vehicle that I couldn't drive because of Santam's incompetence. Thus, over the course of the 5 long months I was waiting for action by Santam's team, I incurred great financial loss. Furthermore, Santam stated they assisted me in selling my uneconomical to repair, (written off) vehicle to their panel beater, this would make me complicit in a ********** and ******* transaction. I asked that this be corrected as this was part of Santam's evidence. I exhausted all appeal avenues at Santam and then referred the matter to the Ombudsman for Short Term Insurance in June 2022. In August 2022 OSTI agreed with Santam's claim response without doing any due diligence. In August 2022 I officially appealed the OSTI decision as it was agreed by the OSTI that they failed to look at the correct information. They then informed me that my matter will be reviewed. On the 31st of October 2022 I was advised that the preliminary recommendation is upheld. I was not satisfied with the response and requested that Santam's written response to my appeal be sent to me as they had already **** before, and I am entitled to have this information for me to review my legal options in this matter. The Ombudsman refused to provide me any reasoning or evidence from the insurer as to why my appeal had been denied.

A point of huge concern to me within my complaint and appeal is the INCORRECT information given by my insurer and accepted by the Ombudsman that I was complicit in breaking the law in terms of selling an uneconomical to repair vehicle, which is not the truth. Should anything come of this vehicle and people are harmed due to the poor workmanship of repair, I cannot be part of this, and I requested that the statement be corrected as part of the evidence given by my insurer or at the very least reassured that action has been taken to remove this vehicle from the road.

However, the Ombudsman has not helped in any part of my complaint (not even to rectify an incorrect statement). In fact, the Ombudsman blatantly advised me that none of my issues are part of the Ombudsman’s jurisdiction i.e., they have no jurisdiction to make a decision if it’s an ex -gratis, a service-related complaint, or damages claim … what then is the insurance ombudsman there for? Surely, they have a responsibility to South African citizens to ensure that insurance companies treat their customers fairly, ensure adequate processes are followed and that no insurance company is engaging in ********, ********** or ******* activity.

In November 2022 I requested my matter be escalated within the OSTI office as once again vital information was overlooked. I had also still not received any communication from the Ombudsman or Santam's written evidence as to why my appeal was unsuccessful. I have taken the best consumer/escalation route and options available to me as a normal citizen.

On the 2nd of December 2022 I received an email from Mr. John Theunissen, who I had been dealing with from the Ombudsman's office, who advised me the following: "I am part of the Escalation Committee that assists the Judge/Ombudsman in issuing final Rulings. As a matter of interest, I put your situation before the committee with very interesting results. I am unfortunately rushing into a meeting but would love to give you more comprehensive feedback on how it would affect your matter. I am noting your matter on my diary for Monday and will advise how the matter will proceed."

I never received anything on that Monday the 5th of December 2022 and have subsequently sent 6 unanswered emails, over the last 3 and a half months, requesting an answer from the OSTI office and have also copied in complaints@santam, as well as dpclegal@santam into those emails.

I need to have proof of how OSTI and my insurer came to this conclusion so that I can litigate accordingly. There must be proof of this decision.

In addition, I have been implicated in a false statement regarding the selling of an uneconomical to repair/unroadworthy vehicle, which is not true and needs to be rectified. I have reports, emails and documents proving that the Ombudsman has failed in their duties as an organization mandated to police the insurance industry.

This entire matter has consisted of 1 year and 4 months of frustration, which has now led me to consider my media options. I had advised the OSTI offices that I would review my options on this, and it was once again ignored.

I have tried to be patient and resolve this matter amicably. I have also worked through the correct escalation channels but have only been met with resistance and incompetence. It has now led me to the point where I will contact the media if I do not receive an appropriate response to my matter. It pains me to say it, but it seems the Ombudsman for Short Term Insurance is yet another failed organization in South Africa that does not care about carrying out their duties.