1 reviews | Active since Jun 2019
OMBUDSMAN FOR SHORT TERM INSURANCE BEING ABOVE THE LAW
It's me again, my case/ ref number is M2451/19
I am not happy on how the office of the ombudsman for short term insurance dealt with my case. My complained was against PMD with regard to a vehicle claim. They refused to pay as they say i was DUI and had made false claims on the claim for saying i was sober.
Here is my reason, i said i was sober because no where in the Accident report it was reported i was under the influence, i thought the accident report is legal and bounding but seems like i was wrong.
The charges against me were withdrawn, so under which reasons PMD had the right to deny my claim, do they carry the higher authority than the court of law? only the Ombudsman for short term insurance know.
Anyway we all know that you cannot bite the hand that feeds you, Ombuds are funded by the very same insurance companies therefore it would be very difficult to rule against them.
If that's not the case why rule against there court and disregard what is on the Accident Report, is the Ombudsman for short term insurance higher than the law? nobody knows. All i need is justice to be fair whether the rulling is against me or the insurer but the law should be app**** fair.
I have reviewed your file in light of the disputes you raised on this platform.
Your claim against the insurer is a civil matter. As such, the insurer bears the onus of proving its grounds against paying the claim on a balance of probabilities standard. This standard must be distinguished from the standard app**** in ******** cases, namely proof beyond a reasonable doubt. Therefore, whilst the initial charge following the incident driver's arrest at the accident scene was not prosecuted, the insurer may decline liability based on the evidence it obtained during the process of validating your claim
I noted from your details of the complaint that you sought to challenge the validity of the breathalyzer test. This is an issue that would need 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 relevant experts to be examined and cross-examined - as would be required to decide on this issue.
We need to also clarify that the Ombudsman's office is not funded by insurers. Although the insurer pays a fee for each complaint that is submitted to OSTI, they are funded by consumers who pay their premiums. This office. therefore, appreciates at all times that our services are funded both by the consumer and by the insurer.
In any event, 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.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.
I have reviewed your file in light of the disputes you raised on this platform.
Your claim against the insurer is a civil matter. As such, the insurer bears the onus of proving its grounds against paying the claim on a balance of probabilities standard. This standard must be distinguished from the standard app**** in ******** cases, namely proof beyond a reasonable doubt. Therefore, whilst the initial charge following the incident driver's arrest at the accident scene was not prosecuted, the insurer may decline liability based on the evidence it obtained during the process of validating your claim
I noted from your details of the complaint that you sought to challenge the validity of the breathalyzer test. This is an issue that would need 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 relevant experts to be examined and cross-examined - as would be required to decide on this issue.
We need to also clarify that the Ombudsman's office is not funded by insurers. Although the insurer pays a fee for each complaint that is submitted to OSTI, they are funded by consumers who pay their premiums. This office. therefore, appreciates at all times that our services are funded both by the consumer and by the insurer.
In any event, 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.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.