1 reviews | Active since Jun 2019
Ombudsman colluding with Insurers to decline our claims
After numerous times writing to them with regard to my case with PMD insurance, claim number CL***. My case number with the OMBUDS M2451/19 the ombud says they uphold the decision made by the insurer in rejecting my claim.
However, they further stated here at hello Peter i can take the matter further in civil court due to the circumstances of the case. Logically if i had the financial muscle to go against a company like PMD i would have done so, but i do not...so does this mean no justice to me due to my lack of finance?
Should you wish to review the case please feel free. I had stated to you before that the case against me which PMD are using as an excuse to reject my claim was withdrawn, secondly stated that the the accident report from SAPS of which i thing it is also a legal and biding document, did not mention anywhere about me being under the influence while driving.
Therefore i find it disingenuous for the office of OMBUD to just conclude that they will uphold the ruling which was made by the insurer without checking all the merits of the claim.
We cannot address the specific merits of your case on this platform in the interests of maintaining confidentiality. Please note that the Assistant Ombudsman dealing with your case will contact you directly, within 3 working days, to address the matter with you.
What I can state however, generally, is that when dealing with the rejection of insurance claims on the ground that the incident driver was under the influence of alcohol, this Office takes into account that the insurance contract falls under the ambit of civil law, not ******** law, where more stringent rules apply. Therefore, 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 on the basis of all the available facts and information submitted by the insurer, despite the incident driver having not been tested for alcohol by way of a blood test and/or convicted of a ******** offence in relation to the incident.
Ayanda Mazwi
Senior Assistant Ombudsman.
We cannot address the specific merits of your case on this platform in the interests of maintaining confidentiality. Please note that the Assistant Ombudsman dealing with your case will contact you directly, within 3 working days, to address the matter with you.
What I can state however, generally, is that when dealing with the rejection of insurance claims on the ground that the incident driver was under the influence of alcohol, this Office takes into account that the insurance contract falls under the ambit of civil law, not ******** law, where more stringent rules apply. Therefore, 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 on the basis of all the available facts and information submitted by the insurer, despite the incident driver having not been tested for alcohol by way of a blood test and/or convicted of a ******** offence in relation to the incident.
Ayanda Mazwi
Senior Assistant Ombudsman.