1 reviews | Active since Jan 2018
Ombudsman sided with Hollard without doing further due diligence, except to decide by quoting Hollard's decision
After Hollard rejected my car claim based on the reason below, I contacted OSTI and a few weeks after that received feedback with which they sided with Hollard without following the matter in detail.
Bearing in mind that even after Hollard rejected, they continued to debit my account (very worrying). My tracker is a basic one and couldn't detect the speed, plus, the road I was travelling on didn't have neither road signs nor boards.
Reason from Hollard: We have assessed your claim. After carefully considering all the available information, we cannot accept the claim for the following reason/s: During the validation process of this claim, it was confirmed that you were travelling at a speed of 94km/h in 60km/h zone. Considering the way in which the accident occurred, we employed the services of an accident reconstruction expert whose finding confirmed that the speed at which you were driving the insured vehicle played a role in the collision.
We refer you to the Section C, Your responsibilities, Clause 3 and Cars section, Comprehensive Cover, Specific exclusions, Clause 9 as stated within your policy wording which reads as follows: C. Your responsibilities 3. You must maintain your property and prevent loss or damage You must maintain your property and take all reasonable steps to prevent loss or damage to your property. Following an event you must take reasonable steps to protect your property from further loss or damage. For example, if a pipe leaks and causes your home to be flooded, you have a responsibility to call in a plumber to turn off the flow of water to prevent further flooding and damage to your property.
9. Specific exclusions – what we do not cover Specific exclusions are in addition to the exclusions set out in the General exclusions section. Certain exclusions may be cancelled if you chose a benefit that gives you cover for something that would normally be excluded.
We will not pay a claim for any of the benefits set out in the Cars (Comprehensive cover) section of this policy that was caused by, or related to any of the following specific exclusions.
c. Exposing your car to situations that clearly have a high risk of loss or damage, for example crossing of a flooded road, or making a U-turn on a highway.
*The last statements doesn't say anything about exceeding the speed limit, which in my case was a thumbsuck*
Reason from OSTI: We refer to the above matter and attached the insurer’s further correspondence dated 05 June 2018, for the insured’s records.
The insured submitted a claim following a motor vehicle accident on 18 December 2017. The insurer rejected the claim on the basis that the insured had failed to take all reasonable steps that would be expected in preventing the loss.
During its assessment of the claim, the insurer appointed an accident reconstruction expert to validate the claim. This expert determined that the insured exceeded the speed limit by driving at a speed of 94km/h on a road where the speed limit is restricted to 60 km/h.
According to the insurer’s accident reconstruction expert, the excessive speed at which the insured was travelling was material to the loss. The accident was reported as a single vehicle accident where the insured lost control of the vehicle, and subsequently rolling the vehicle. The accident reconstruction expert concluded that the insured exhibited reckless behaviour by driving at an inappropriate speed that was too high for the circumstance, specific geometric road design, and time of day. Furthermore, he neglected to take all the existing possible risk factors into account to avert or minimise his risk in a possible incident situation.
The insured submitted that the insurer’s accident reconstruction expert made assumptions based on his previous experience and not the information relating to the incident at hand that he exceeded the speed limit. Furthermore, no negligence could be proven on his side as there was no alcohol involved and this was a pure accident.
No independent expert evidence has been provided by the insured to disprove the findings of the independent expert appointed by the insurer.
The insurer has established, on the balance of probabilities that the insured failed to take reasonable measures to prevent or minimize the loss or damage to the vehicle. We find that the calculated/reconstructed speed at which the insured had been driving just before the accident were the circumstances, reckless. On the evidence submitted the speed at which the insured was driving just before the accident was the main contributing factor to the collision.
Based on the abovementioned discrepancies and evidence available to us, we are not in a position to fault the insurer’s stance.
We are accordingly proceeding to close our file.
*OSTI never contacted me to request my Indepedent Expert*
This was my 3rd claim from Hollard and I strongly believe that like other insurers they only enjoy receiving money from it's clients. There were no markings related to my accident even from the "expert's" report, so how did he come to his conclusion. During the investigation, they kept asking if I was drunk. They tried to get my Tracker record which had nothing.
After my post here in HelloPeter Hollard lured me into reverting to their internal process to log a Dispute and from the email extraction below, it shows that no further review was done, they just wanted me to refrain from using this platform:
Email from a Dispute Resolution Specialist: From: Robert Lloyd Sent: 25 May 2018 11:53 AM To: Desmond Chinsamy <***> Cc: Janine Wilken <***> Subject: T149/18M / M TSITA / ***
Hi Desmond / Janine,
Please see the attached letter from client (just the part with regards to the premiums that were still debited) after the incident.
Please let me know if there is a refund due, how much and proof once refunded.
Desmond, ignore the rest of the letter from the client as it takes this matter no further, I will advise the Ombudsman (unless you want to comment on anything?)
Thanks, Rob
Alternative Dispute Resolution Specialist | Customer Centricity | South Africa
*A Hollard employee told his colleague to IGNORE MY LETTER and only focus on MY QUERY REGARDING a continuous DEBIT FROM MY ACCOUNT*
- According to our records, our file was closed almost 18 months ago in June 2018. You have simply run out of time to have the matter revisited. If you sought to have the closure or the reasons re-considered, you should have approached our office earlier for this.
- Considering the content of your own post, it would appear that the insurer provided an expert report on the basis of which it was concluded that you drove recklessly by speeding in circumstances in which this was inappropriate, resulting in the damage to the vehicle. This is clearly a policy exclusion and the insurer would be entitled to decline liability for the claim on this basis.
- The vehicle was even airborne (a clear indication of a high speed).
- I also note that in your own letter included in the e-mails of 4 April 2018 and 15 May 2018 you inadvertently confirmed the high speed by blaming the 228 KW power of your car and its responsiveness (which responsiveness you ought to have known about).
- The accident occurred in a residential/ built- up or urban zone (Lebowakgomo Zone A) which would mean that the speed limit can be presumed to be 60km/h even when there is no signage (assuming that your allegation is correct that there was no signage). You have also conceded your own knowledge of the presumption that it would be a 60km/h zone.
- Your allegation that you were not required to provide your own report is false. Our letter of 2 May 2018 clearly states this in the third paragraph.
- If you believed you have a case, you should have sought legal advice and proceeded in accordance therewith.
- Please accept that we will not be able to assist you... both on the merits and as a matter of process and procedure.
- It is likely that at this stage you will not be able to pursue the matter further in court either.
Yours faithfully
Senior Assistant Ombudsman
- According to our records, our file was closed almost 18 months ago in June 2018. You have simply run out of time to have the matter revisited. If you sought to have the closure or the reasons re-considered, you should have approached our office earlier for this.
- Considering the content of your own post, it would appear that the insurer provided an expert report on the basis of which it was concluded that you drove recklessly by speeding in circumstances in which this was inappropriate, resulting in the damage to the vehicle. This is clearly a policy exclusion and the insurer would be entitled to decline liability for the claim on this basis.
- The vehicle was even airborne (a clear indication of a high speed).
- I also note that in your own letter included in the e-mails of 4 April 2018 and 15 May 2018 you inadvertently confirmed the high speed by blaming the 228 KW power of your car and its responsiveness (which responsiveness you ought to have known about).
- The accident occurred in a residential/ built- up or urban zone (Lebowakgomo Zone A) which would mean that the speed limit can be presumed to be 60km/h even when there is no signage (assuming that your allegation is correct that there was no signage). You have also conceded your own knowledge of the presumption that it would be a 60km/h zone.
- Your allegation that you were not required to provide your own report is false. Our letter of 2 May 2018 clearly states this in the third paragraph.
- If you believed you have a case, you should have sought legal advice and proceeded in accordance therewith.
- Please accept that we will not be able to assist you... both on the merits and as a matter of process and procedure.
- It is likely that at this stage you will not be able to pursue the matter further in court either.
Yours faithfully
Senior Assistant Ombudsman
2. Yes they did provide and that was my despute, that it was a thumb suck, it was an assumption.
3. No one could ever decide on how to have an accident and how the vehicle should, or how it should, which is what makes me even more angrier, what does the body damage have to do with speed, not even sure what it hit?
4. I never mentioned anything regarding high speen other than saying the obvious, it's a high performance car - logic tells you that it's take off and changing of gears is fast. I ought to have known what, that I'll loose control, and that owning a powerful car means that one will not have an acciden? WOW
5. That's what K53 says, but I need proof that I exceeded that speed. When the so called expert inspection was done, it was over a week after my accident, no markings, just speculation on how the accident happened. Hence my conclusion that you guys are siding with Hollard.
6. This is the content of your letter:
Insurer : Hollard Insurance Policy/Claim number : *** Our ***/18M We refer to the above matter and advise that the insurer has responded to your complaint, a copy of which is enclosed. It is important that our office obtain all relevant information and documentation before reaching a decision on the complaint. It is also important to afford each party an opportunity to properly address all the issues raised and to make appropriate submissions. Please carefully read through the insurer’s answer and, within a period of 14 days, furnish us with your written reply. In particular, please advise us whether you accept as correct or reject the factual allegations contained in the insurer’s answer. If you reject any fact or allegation made by the insurer, please provide reasons and evidence, if applicable. We look forward to receiving your written reply within 14 days.
*Where does it state that I need to provide proof from an expert?*
*If I was expected to read between the lines, how would I pay the expert?*
7. Legal representation isn't affordable to us ordinary citizens, and it's an insult coming from OSTI representative to mention that "If I believed I had a case". Why did I approach you in the first place? That's an irresponsible and damning statement.
8. I believe that justice needs to be served. Why did you guys not bother asking why Hollard continued debiting my premiums?
9. Even matters that where put to rest regarding ***** and all crimes can be revived in church, and from the arrogance that I'm receiving from this response, justice shall prevail and we'll have to see about that.
2. Yes they did provide and that was my despute, that it was a thumb suck, it was an assumption.
3. No one could ever decide on how to have an accident and how the vehicle should, or how it should, which is what makes me even more angrier, what does the body damage have to do with speed, not even sure what it hit?
4. I never mentioned anything regarding high speen other than saying the obvious, it's a high performance car - logic tells you that it's take off and changing of gears is fast. I ought to have known what, that I'll loose control, and that owning a powerful car means that one will not have an acciden? WOW
5. That's what K53 says, but I need proof that I exceeded that speed. When the so called expert inspection was done, it was over a week after my accident, no markings, just speculation on how the accident happened. Hence my conclusion that you guys are siding with Hollard.
6. This is the content of your letter:
Insurer : Hollard Insurance Policy/Claim number : *** Our ***/18M We refer to the above matter and advise that the insurer has responded to your complaint, a copy of which is enclosed. It is important that our office obtain all relevant information and documentation before reaching a decision on the complaint. It is also important to afford each party an opportunity to properly address all the issues raised and to make appropriate submissions. Please carefully read through the insurer’s answer and, within a period of 14 days, furnish us with your written reply. In particular, please advise us whether you accept as correct or reject the factual allegations contained in the insurer’s answer. If you reject any fact or allegation made by the insurer, please provide reasons and evidence, if applicable. We look forward to receiving your written reply within 14 days.
*Where does it state that I need to provide proof from an expert?*
*If I was expected to read between the lines, how would I pay the expert?*
7. Legal representation isn't affordable to us ordinary citizens, and it's an insult coming from OSTI representative to mention that "If I believed I had a case". Why did I approach you in the first place? That's an irresponsible and damning statement.
8. I believe that justice needs to be served. Why did you guys not bother asking why Hollard continued debiting my premiums?
9. Even matters that where put to rest regarding ***** and all crimes can be revived in church, and from the arrogance that I'm receiving from this response, justice shall prevail and we'll have to see about that.
I recall seeing e-mails about a refund of premiums collected after the accident and that the insurer was going to refund you. After all this time, I presumed that this was done. That is why I did not deal with this aspect further. The actual debit order deduction is not a problem as such as it is system driven or automated.
If they did refund, there would be nothing further to do about this aspect.
Again, you should have raised it more than 18 months ago.
This is my last response on this matter as we will not be able to assist you with anything at this stage.
Yours faithfully
Peter Nkhuna
Senior Assistant Ombudsman
I recall seeing e-mails about a refund of premiums collected after the accident and that the insurer was going to refund you. After all this time, I presumed that this was done. That is why I did not deal with this aspect further. The actual debit order deduction is not a problem as such as it is system driven or automated.
If they did refund, there would be nothing further to do about this aspect.
Again, you should have raised it more than 18 months ago.
This is my last response on this matter as we will not be able to assist you with anything at this stage.
Yours faithfully
Peter Nkhuna
Senior Assistant Ombudsman
The issue isn't about receiving refunds, it's how they continued to debit even after they rejected, it's because they were hoping you side with with them, as usual, in order for them to pay me back rather than settle my claim.
Reminding me of the 18 months still doesn't resolve my dissatisfaction as well and as a consumer I must complain whenever I'm not satisfied and voice out my concerns.
Tone of your response and attitude isn't helping as well and this can't be over unless I'm sure this matter is well handled.
The issue isn't about receiving refunds, it's how they continued to debit even after they rejected, it's because they were hoping you side with with them, as usual, in order for them to pay me back rather than settle my claim.
Reminding me of the 18 months still doesn't resolve my dissatisfaction as well and as a consumer I must complain whenever I'm not satisfied and voice out my concerns.
Tone of your response and attitude isn't helping as well and this can't be over unless I'm sure this matter is well handled.