1 reviews | Active since Aug 2018
Ombudsman sides with Insurance companies.
I lodged a claim for review with the Ombudsman, after Standardbank Home Insurance declined my claim to have my house's roof repaired (following a storm, which caused a leak), on the basis of an *********** inspector sent for the inspection, by the bank.
This Inspector could not even identify where the leak originated from & the photos he submitted was a full 180 degrees from the place of the leak. Further, he commented that the hole in my ceiling (caused by the leak) was an old hole.
I submitted photos to the Ombudsman, showing the position where the leak originated from, as well as the path that the water ran (by means of tying a colorful string) to cause the hole in the ceiling. I also submitted a (history) weather forecast, which indicated the weather on the date of my damage.
The Ombudsman refused to take my evidence in consideration & sided with Standardbank, giving the following reasons: 1.) Standardbank have no record of claims in the same area. (Although I know of 2 houses which incurred damage at the same time, but with different insurance companies.) 2.) They do not have the facilities & means to verify who is right, or he is wrong with their assessments, so they choose to side with the bank.
This was a huge shock to me, as I thought that the Ombudsman was there to protect the Consumer, which is most certainly not the case. I also know understand why Insurance companies boast with high percentages of cases which is not overturned against their decision.
The bottom line: The Ombudsman's decision is based on the evidence presented by the insurance companies (even if incorrect). The consumer is not considered.
Dear Arlou Kriel
I have not had the opportunity to review your file because you did not provide us with the reference number.
What I can however state is that the office considers all of the evidence provided by the respective parties and since your claim against the insurer is a civil matter, a finding is made on a balance of probabilities. When evaluating the probabilities, the evidence is not considered as separate enquiries, but rather as a single investigation into the acceptability or otherwise of the versions put forward by both parties. Any damage or loss which does not fall within the limitations of the policy is not covered.
I am prepared to comment specifically on your matter once I am in receipt of the reference number.
Yours faithfully
Ayanda Mazwi
Senior Assistant Ombudsman
Dear Arlou Kriel
I have not had the opportunity to review your file because you did not provide us with the reference number.
What I can however state is that the office considers all of the evidence provided by the respective parties and since your claim against the insurer is a civil matter, a finding is made on a balance of probabilities. When evaluating the probabilities, the evidence is not considered as separate enquiries, but rather as a single investigation into the acceptability or otherwise of the versions put forward by both parties. Any damage or loss which does not fall within the limitations of the policy is not covered.
I am prepared to comment specifically on your matter once I am in receipt of the reference number.
Yours faithfully
Ayanda Mazwi
Senior Assistant Ombudsman
Dear Arlou Kriel
Thank you for providing us with your reference number. I have now had the opportunity to review your file and agree with the decision made.
As I had already indicated, this office considers all of the evidence provided by the respective parties and since your claim against the insurer is a civil matter, a finding is made on a balance of probabilities. The insurer's assessment of the damage did not indicate any storm damage to your property. We considered the assessment photographs provided and noted that there was a small hole in the ceiling which appeared to indicate that there were previous leaks. An inspection of the inside of the roof cavity did not show any signs of storm damage.
We note that you dispute the accuracy of the insurer's report. However, you did not submit a report or sufficient evidence which proves that the damage to your property was related to the storm. As the claimant, you bear the onus of proving that the claim falls within the ambit of the cover provided and establish a valid claim. In order to discharge this onus, you must demonstrate not only that there was a storm, but that the specific damage you have claimed for was due to the storm. It is only then that this office would be placed in a position to provide any further assistance.
After careful deliberation, we found that there was insufficient evidence to justify that you had a valid claim against the insurer and proceeded to close our file.
Yours faithfully
Ayanda Mazwi
Senior Assistant Ombudsman
Dear Arlou Kriel
Thank you for providing us with your reference number. I have now had the opportunity to review your file and agree with the decision made.
As I had already indicated, this office considers all of the evidence provided by the respective parties and since your claim against the insurer is a civil matter, a finding is made on a balance of probabilities. The insurer's assessment of the damage did not indicate any storm damage to your property. We considered the assessment photographs provided and noted that there was a small hole in the ceiling which appeared to indicate that there were previous leaks. An inspection of the inside of the roof cavity did not show any signs of storm damage.
We note that you dispute the accuracy of the insurer's report. However, you did not submit a report or sufficient evidence which proves that the damage to your property was related to the storm. As the claimant, you bear the onus of proving that the claim falls within the ambit of the cover provided and establish a valid claim. In order to discharge this onus, you must demonstrate not only that there was a storm, but that the specific damage you have claimed for was due to the storm. It is only then that this office would be placed in a position to provide any further assistance.
After careful deliberation, we found that there was insufficient evidence to justify that you had a valid claim against the insurer and proceeded to close our file.
Yours faithfully
Ayanda Mazwi
Senior Assistant Ombudsman