JJ
Jan-Abraham Joubert
1 reviews | Active since Apr 2020
09 Jul 2020, 08:30
OSTI - For the insurer not the insured (The insurers friend)
Unimpressed with the service of OSTI and the persons that dealt with my case (J105/20).
After submitting evidence to dispute the decision to uphold the insurers findings, the basic reply I received from OSTI was although I provided substantial factual evidence which may refute the insurers evidence they still cannot assist me and deemed my case to be closed.
What is the purpose of OSTI if they cannot assist you after you had provided substantial factual evidence to dispute a insurers finding? Basically they only a communication network between the insured and the insurers without any purpose in my eyes.
The insured has no benefit with OSTI!!
In addition if you lay a complaint do not expect any feedback on emails, the online portal or phone calls because it will not happen. With every email inquiry, online inquiry or phone call I did not get through with I received no reply from OSTI, they will only respond with their findings (and don't expect that to be a quick process).
Still awaiting feedback on my mail to which I expressed my disappointment on the outcome of the case and for my phone call to be returned.
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Replies (5)0
Replies (5)
Ombudsman for Short Term Insurance's replyOfficial
10 Jul 2020, 13:47Dear Jan-Abraham Joubert
When deciding a complaint, this Office will consider all the relevant facts and arguments. The outcome will be based on the version of events that seems the more likely or probable. This is called deciding on a “balance of probability” and refers to the standard test to be used when deciding civil (as opposed to ********) disputes.
I have looked into your complaint and confirmed that, based on the evidence, the insurer made out its case on which to contest liability on the basis that the tile damage occurred as result of such poor workmanship, which is an exclusion in the policy. The decision was upheld based on the proximate cause of the damage.
We apologise for the delays in attending to your complaint. This is due to the high caseloads dealt with in the office. We do however assure you that each matter is handled with the same degree of urgency and competency.
Your latest email dated 6 July 2020 is being considered by the relevant department, which will revert to you by the end of the day on Monday 13 July 2020.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.
When deciding a complaint, this Office will consider all the relevant facts and arguments. The outcome will be based on the version of events that seems the more likely or probable. This is called deciding on a “balance of probability” and refers to the standard test to be used when deciding civil (as opposed to ********) disputes.
I have looked into your complaint and confirmed that, based on the evidence, the insurer made out its case on which to contest liability on the basis that the tile damage occurred as result of such poor workmanship, which is an exclusion in the policy. The decision was upheld based on the proximate cause of the damage.
We apologise for the delays in attending to your complaint. This is due to the high caseloads dealt with in the office. We do however assure you that each matter is handled with the same degree of urgency and competency.
Your latest email dated 6 July 2020 is being considered by the relevant department, which will revert to you by the end of the day on Monday 13 July 2020.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.
Ombudsman for Short Term Insurance's reply10 Jul 2020, 13:47
Official
Dear Jan-Abraham Joubert
When deciding a complaint, this Office will consider all the relevant facts and arguments. The outcome will be based on the version of events that seems the more likely or probable. This is called deciding on a “balance of probability” and refers to the standard test to be used when deciding civil (as opposed to ********) disputes.
I have looked into your complaint and confirmed that, based on the evidence, the insurer made out its case on which to contest liability on the basis that the tile damage occurred as result of such poor workmanship, which is an exclusion in the policy. The decision was upheld based on the proximate cause of the damage.
We apologise for the delays in attending to your complaint. This is due to the high caseloads dealt with in the office. We do however assure you that each matter is handled with the same degree of urgency and competency.
Your latest email dated 6 July 2020 is being considered by the relevant department, which will revert to you by the end of the day on Monday 13 July 2020.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.
When deciding a complaint, this Office will consider all the relevant facts and arguments. The outcome will be based on the version of events that seems the more likely or probable. This is called deciding on a “balance of probability” and refers to the standard test to be used when deciding civil (as opposed to ********) disputes.
I have looked into your complaint and confirmed that, based on the evidence, the insurer made out its case on which to contest liability on the basis that the tile damage occurred as result of such poor workmanship, which is an exclusion in the policy. The decision was upheld based on the proximate cause of the damage.
We apologise for the delays in attending to your complaint. This is due to the high caseloads dealt with in the office. We do however assure you that each matter is handled with the same degree of urgency and competency.
Your latest email dated 6 July 2020 is being considered by the relevant department, which will revert to you by the end of the day on Monday 13 July 2020.
Yours faithfully,
Ayanda Mazwi
Senior Assistant Ombudsman.
JJ
Jan-Abraham Joubert's updateReviewer Update
11 Jul 2020, 06:37Yes the insurer based their case on faulty workmanship, to which I was provided the opportunity to present facts to contest this decision to which I did.
I provided sufficient factual evidence to proved that their case is based on their opinion that it is faulty workmanship. I provided information that proves that what they see as faulty workmanship actually gets practiced in the industry. How can this then be classified as faulty if it is practiced?
So in the end it doesn't matter if it is an exclusion in the policy, because it was an opinion of theirs and not actual facts.
But I have been down this road, it doesn't matter how strong case the insured has the insurer always gets the benefit.
I am not worried about the delay in responses I am disappointed that in some cases I received no response at all and that phone calls were not returned at all after a message was left with the secretary.
I provided sufficient factual evidence to proved that their case is based on their opinion that it is faulty workmanship. I provided information that proves that what they see as faulty workmanship actually gets practiced in the industry. How can this then be classified as faulty if it is practiced?
So in the end it doesn't matter if it is an exclusion in the policy, because it was an opinion of theirs and not actual facts.
But I have been down this road, it doesn't matter how strong case the insured has the insurer always gets the benefit.
I am not worried about the delay in responses I am disappointed that in some cases I received no response at all and that phone calls were not returned at all after a message was left with the secretary.
JJ
Jan-Abraham Joubert's update11 Jul 2020, 06:37
Reviewer Update
Yes the insurer based their case on faulty workmanship, to which I was provided the opportunity to present facts to contest this decision to which I did.
I provided sufficient factual evidence to proved that their case is based on their opinion that it is faulty workmanship. I provided information that proves that what they see as faulty workmanship actually gets practiced in the industry. How can this then be classified as faulty if it is practiced?
So in the end it doesn't matter if it is an exclusion in the policy, because it was an opinion of theirs and not actual facts.
But I have been down this road, it doesn't matter how strong case the insured has the insurer always gets the benefit.
I am not worried about the delay in responses I am disappointed that in some cases I received no response at all and that phone calls were not returned at all after a message was left with the secretary.
I provided sufficient factual evidence to proved that their case is based on their opinion that it is faulty workmanship. I provided information that proves that what they see as faulty workmanship actually gets practiced in the industry. How can this then be classified as faulty if it is practiced?
So in the end it doesn't matter if it is an exclusion in the policy, because it was an opinion of theirs and not actual facts.
But I have been down this road, it doesn't matter how strong case the insured has the insurer always gets the benefit.
I am not worried about the delay in responses I am disappointed that in some cases I received no response at all and that phone calls were not returned at all after a message was left with the secretary.
Ombudsman for Short Term Insurance's replyOfficial
13 Jul 2020, 08:36Dear Mr. Jan-Abraham Joubert
Please note that the relevant consultant will contact you today to discuss this matter with you.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman
Please note that the relevant consultant will contact you today to discuss this matter with you.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman
Ombudsman for Short Term Insurance's reply13 Jul 2020, 08:36
Official
Dear Mr. Jan-Abraham Joubert
Please note that the relevant consultant will contact you today to discuss this matter with you.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman
Please note that the relevant consultant will contact you today to discuss this matter with you.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman
JJ
Jan-Abraham Joubert's updateReviewer Update
20 Jul 2020, 08:03Was told that I was going to be contacted by the end of the day the 13/07/2020. A week later and I have not been contacted as promise.
JJ
Jan-Abraham Joubert's update20 Jul 2020, 08:03
Reviewer Update
Was told that I was going to be contacted by the end of the day the 13/07/2020. A week later and I have not been contacted as promise.
JJ
Jan-Abraham Joubert's updateReviewer Update
05 Aug 2020, 09:47Cant believe after providing factual evidence "as stated by OSTI" to oppose the insurers opinion they had, OSTI still stands by the rejection of the claim based on their "views" of the situation as stated in the feedback report. How do you base decisions on opinions or views (Something you think) be considered over facts (Something that can be proved)? Pathetic to say the least.
JJ
Jan-Abraham Joubert's update05 Aug 2020, 09:47
Reviewer Update
Cant believe after providing factual evidence "as stated by OSTI" to oppose the insurers opinion they had, OSTI still stands by the rejection of the claim based on their "views" of the situation as stated in the feedback report. How do you base decisions on opinions or views (Something you think) be considered over facts (Something that can be proved)? Pathetic to say the least.