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Mogale L

1 reviews | Active since Jan 2020

30 Jul 2020, 07:57

L5/20 OSTI not willing to share information.

L5/20

The office of ombudsman is not willing to tell me what kind of information we are waiting from MiWay Insurance , MiWay Insurance was given time extension to submit that information, but unfairly I’m left in the dark and I don’t even know the exact due date of that time extension.

Now I can see why so many people say OSTI help insurance to reject claims.

The OSTI have more than enough evidence from both parties to make a fair decision and decide my valid claim in my favor and recommend the insurance to pay it , but no they don’t want to do that , instead they request more information from the insurance so that the insurance get more time extension to create false evidence and achieve their plan to say the office of OSTI has no longer the jurisdiction to deal further with these matter , and in that way they know that most consumer will not manage to challenge the insurance in court because of more cost involved.

I need to see the requested information and the exact due date given to MiWay Insurance , that’s fair.

Thanks

0
Replies (5)
Ombudsman for Short Term Insurance
Ombudsman for Short Term Insurance's reply30 Jul 2020, 10:14
Official
Dear Mogale Lekoloane

Please note that I have reviewed the contents of your file. 

Our Office is only in a position to make a recommendation on the outcome of the complaint when both parties have been given a fair opportunity to address the matter. 

You provided detailed submissions on 5 July 2020. In the interests of fairness, the insurer has been given an opportunity to respond. This part of our process is to enable us to have a full picture of the relevant facts to ensure an informed outcome. 

The Assistant Ombudsman will address you further in the matter when she receives the insurer's reply. 

Yours faithfully, 

Ayanda Mazwi 
Senior Assistant Ombudsman. 
ML
Mogale L's update30 Jul 2020, 12:32
Reviewer Update
Dear Ayanda Mazwi

Kindly note that,

all I’m asking is to see the communication between the OSTI and MiWay Insurance, I want to see the requested information and the insurance respond and a due date, that can’t be hard to give me. Because I have a concern about the information that OSTI request from MiWay Insurance, for example:

MiWay Insurance expert report clearly shows that they have extracted electronic data from my vehicle on August 2019, but after that OSTI request the insurance if they are going to hire another expert to extract electronic data from my vehicle. That part is already being completed but still OSTI on its own want the insurance to address it again. Why ? Is because OSTI want to give the insurance unnecessary time extension to come up with extra lies evidence about the electronic data ? If not then why was it requested while it is clear that it was addressed 10 months back?

The requested information that I want to see you will find out that is already being addressed, Hence I want to see what is being requested because it might be creating unnecessary delay on my case and at the same time giving the insurance unfair opportunity to create false evidence.

MiWay Insurance have addressed the matter fully as far as I’m concerned. What is left is for OSTI to make a fair decision in my favor. Unless OSTI want to help the insurance to come up with false evidence to create a situation where OSTI will say they don’t have power to make a decision on these matter.

Please forward me the requested information. Is simple and fair. Then I will wait for recommendation.

Thank you
Mogale
ML
Mogale L's update30 Jul 2020, 19:20
Reviewer Update
Dear Ayanda Mazwi

Kindly note that my email written on the 5 July 2020 I was simply responding to the insurance expert report and highlighting some clear findings in my expert report, The Insurance had a fair long opportunity to go through all these experts reports, they have done that and made their full response based on those reports. What is left is for OSTI to make recommendation based on evidence submitted.
The insurance expert says is unscientific to criticize another expert report but at the same time he clearly criticized my expert work in his new comments
The last paragraph of my expert report & other findings clearly states the findings that will help OSTI to finalize the matter, The Insurance clearly saw that but they simply ignored that and submit that my expert didn’t provide any finding to finalize the matter. So now you tell me that they were given time extension to respond to these clear things ? They have already responded , what more must they say because is clear they are ******* and simply not willing to face the truth.
My expert report clearly shows what is used to prepare his report but again The Insurance when they respond they ignored that and say my expert report is based on their expert report, But OSTI want to give them time extension to respond again.
Is clear to me, OSTI and the Insurance that the insurance expert speculated on full braking without evidence, and he also admitted in his comments, but still OSTI want to give the insurance time extension to respond.
The insurance expert said his calculations are not based on braking analysis which is a clear lie because on the same paragraph he speaks about harsh braking which means braking analysis, The insurance saw that and submit their respond, but now OSTI want them to respond again, Why ?
The insurance expert said is very unlikely to survive a frontal collision without safety belt and without brakes at 120km/h . The insurance expert admitted that he doesn’t really know the final resting position of the cars And he said that doesn’t matter to him even if they were moved before they were captured. So the time extension given to insurance is to do what? Is clear that the insurance is not truthful and they are only planning to come up with with more tricks to avoid paying my claim unfortunately OSTI is giving them time to do that.
These time extension is unnecessary because my letter of 5 July 2020 I was addressing clear simple things that the insurance is aware of and they responded after going through them.
We cannot give a company unnecessary time extension to address simple things that they saw and simply ignore, that is unfair to me.
Next thing I will be told that OSTI have no power to deal further with these case, that’s the next approach by the insurance.

Thanks
Mogale

Ombudsman for Short Term Insurance
Ombudsman for Short Term Insurance's reply31 Jul 2020, 09:57
Official
Dear Mogale Lekoloane
 
Concerning your second post herein, please note that in terms of confidentiality provisions under OSTI's Terms of Reference on which our mandate is governed, we are not in a position to provide you copies of correspondence addressed by this Office to the insurer, in the same way, that we cannot share correspondence addressed to you by our Office with the insurer. OSTI will, however, provide both sides with all of the information given to it. Further provisions concerning confidentiality are also contained in the Application for Assistance Form when you lodged the complaint. 
 
I have personally reviewed the merits of this dispute and do not agree with your view that the facts/findings are "clear". This matter has taken a significant amount of time to be resolved in this office in our investigation, attempts to narrow the issues, and facilitate a mutual resolution. At best, the facts in this matter give rise to a factual dispute. 

We refer in this regard to articles 5.1 and 7.3 of our Terms of Reference, which respectively and essentially state that the Ombudsman may at his discretion decide that a matter be referred to a court or a more appropriate forum; and that the Ombudsman does not have the jurisdiction to deal with material disputes of fact. 

A factual dispute needs to be resolved in a Court of Law, where a formal hearing may be held. The Ombudsman has a limited adjudicative function, and can therefore not hold a formal hearing allowing the experts to be examined and cross-examined. Where there are such disputes, testing the opposing witnesses in this way the only way to arrive at a proper conclusion. 

The above is also consistent with how you are conducting this matter, i.e. as if it were a trial. The evidence presented by the insurer is being contested in a manner that requires the cross-examination of its expert. This is not in line with the process of the Ombudsman where records, documents, and recordings are used in evaluating disputes. Your third post above implies, in this regard, that the Ombudsman’s process is not suitable for the resolution of this dispute. 

In my view, this matter has all the hallmarks of a dispute which may need to be tested in court. If the Assistant Ombudsman saw it fit to request the insurer's expert to clarify an issue, I am certain that this was for a good reason. This Office appreciates the expensive and drawn out process of litigation and will make every effort to be placed in a position to make a recommendation. The likely result, if we cannot determine a clear outcome, is that the matter will be referred to court. 
 
In conclusion, you have raised several allegations of this office colluding with the insurer or displaying bias in its favour. These allegations were not only unfounded but also vehemently denied. OSTI takes its role as an impartial and independent forum very seriously and deals with each complaint that is lodged with it in this way. When deciding on the merits of a complaint, we consider all the relevant facts, arguments and evidence put forward by the parties, and our recommendations are based on the law and, where appropriate, on what we believe is fair and reasonable. 

As previously stated, The Assistant Ombudsman will address you further in the matter when she receives the insurer's reply. 
 
 Yours faithfully, 
 
Ayanda Mazwi 
Senior Assistant Ombudsman.
ML
Mogale L's update31 Jul 2020, 14:53
Reviewer Update
Dear Ayanda Mazwi

Thanks for your reply, now I know why you can’t forward me that communication.

Like I said above I was expecting a reply to say these case must go to court, that was suggested my the insurance on their latest reply to OSTI On the 8 June 2020 , even though is clear thats is the plan to cheat me.

Both the expert reports proves that the third party just reversed from a Pub at midnight into my road and I did took action to avoid the collision but i should be blamed and punished , I wonder which traffic law is that.
A pub with previous car theft and immediately when I rush out to my passenger, a stranger rushed to my door and stole my car keys , which is evident that if my car was drivable it was going to be ******.
There is a recording consultantion between myself and the insurance expert where he clears everything and proves that I have a valid claim, the insurance expert further proves that even if I had app**** brakes the collision was still going to occur. So OSTI must just in favor of the insurance ignore these oral evidence and suggest that we go to court?

Even when you go through the insurance expert report on its own his findings doesn’t make sense and they contradict each other, his findings and my expert findings are not equally probable.

The third party reversed from my left to my right and I swerved to my right then the collision occurred, then insurance expert claim that the third party vehicle then came to rest about 15.7m to the left pavement because of my car impact, Then which force caused the third party vehicle to go back to the left Pavement , My car ? No.
On a balance of probability that’s it’s impossible, The third party vehicle was driven to the left pavement after the collision to get it out of way from tar road. There were many cars that were parked infront of Loxion PUb during the collision, so again on balance of probability it is impossible to say the third party vehicle came to rest on the left pavement because it should have then crashed into other vehicles and that did not happen.

I supp**** a clear video where I measure exactly from the impact point used by the insurance expert to my car rest position and the distance is exactly 16.7m but the insurance expert used 19.8m. You can see that my measurement is correct which means automatically the insurance expert measurements is wrong, without cross examining him.

No safety belt , the insurance expert report agrees and the Insurance expert then claim that I was traveling at 134km/h at a frontal collision and I know that I was doing 60km/h, is the reason I was able to get out of car within seconds after the collision unharmed and even answered my phone call , if I was doing 134km/h probably I was going to die at the scene, My expert calculated a speed of about 50km/h based on physical evidence and correct inputs . I supp**** crash test to prove that the damages to my vehicle are possible at the speed of 50km/h to 64km/h. Even the insurance expert adviced me to look at crash test. So When you look above then on balance of probability to say my car was speeding is not probable and is highly impossible and not being reasonable. The findings of the insurance expert and the findings of my expert cannot be equally probable and besides that I know as a fact that I was traveling at low speed.

We don’t need to cross examine the insurance expert, I submitted long ago that i never app**** brakes on my car and based on physical evidence of the scene and knowledge my expert confirmed that I never app**** brakes and the insurance expert through his comments proved that he speculated on harsh braking without any evidence, that’s was his own words on his new report . So why would we cross examine him in Court? On probability he is completely wrong and my expert and myself we are correct, You cannot tell me that we are equally probable, there is absolutely no evidence to support his speculations.

I supp**** the pictures of my car from the scene to compare them with the pictures at Trident panel beaters to prove that my car was stripped and some parts were ****** before the insurance expert can inspect my vehicle, which means you can’t conclude that all the damages on my car are as a results of the collision. That’s doesn’t need cross examination of the insurance expert.
I have provided more sufficient evidence to prove that the insurance is wrong and Im not only saying I’m correct I have submitted evidence to prove that I’m correct.

I personally supp**** a simple calculation that proves that the insurance expert used friction coefficient of 1 in his calculations, that was after the insurance expert submitted that he never used friction coefficient of 1 in his calculations. So that also need cross examination while is clear that the insurance expert is wrong?

With respect the insurance have not proved their case to reject my valid claim that i have proved 100% and there absolutely no reason to go to court.

But it’s fine I’ll wait for person working on my case to respond directly to my mail when she complete her job.

Thanks.
Mogale Lekoloane.