Pathetic service by *********** staff since 2022

I've lodged a complaint with the Ombudsman in November last year. The complaint was against OUTsurance, and I had to ask for feedback as none was forthcoming from the office of the Ombudsman. When I reported the undue delay to the Ombudsman, I received a haphazard resolution from an assistant which did not deal with the gist of the complaint. I've been following up and receiving read receipts to my e-mails but no response to my escalation of the matter in terms of their process. Why can't the ombudsman make a decision based on the law and fairness. What is the role of the Ombudsman? Is it to get the complainant and the insurer talking again as I was never asked my side of the story, yet they made a decision based on incorrect findings and unfounded/uninformed interpretations strengthening the perception of blatant bias toward the insurer. What's the point of me asked the Ombudsman to resolve a legitimate complaint if they do not respond and I have to constantly remind them to send me and update or reply which is just ignored. The ombudsman must make it clear if they are affiliated with these insurance companies, so we don't waste our time contacting them. As a result of the misrepresentations by the employees/brokers/agents of the insurer it cannot be deducted that the insured is also fully aware of the premium charged or to which extent it would be increased by the insurer contrary to the facts and figures provided by its employees. Further the aforementioned does also not make the insured not entitled to rely on the guarantee by the insurer of the premium for 12 months from inception regardless of whether the insured claims or not. Their initial recommendation in fact condones misrepresentations by the staff of the insurer and does not deal with their false advertising. As their recommendation in the matter is not legally sound on several aspects and did not follow the standard complaints handling procedure it cannot be reasonably accepted by the parties thus the referral which could ultimately end up with the escalation committee for consensual determination and issuing of a fair and legally sound ruling. Sound judgment and decision-making can be defined as one's ability to objectively assess situations or circumstances using all the relevant information and apply past experience in order to come to a conclusion or make a decision and there is an assumption that the best decisions are rational based on logic and factual information which they have seemed to overlook in this matter. The level of serving here is pathetic and I believe the Ombudsman is stalling and wants me to be fed up and let go of my claim all together. Where can I report the Ombudsman as it is clear that they are not delivering the service they ought to? Their office is not impartial, and they don’t collect information from both parties, independently, before making a recommendation. They just adjudicate a matter, and do not apply equity or fairness. Like several other Hello Peter complainants their process seem to be a total waste of time. Seems like they’re going around in a circle when they are supposed to be the ones helping parties to come to a solution. In our current case, we still await feedback from the escalation to the next level of management so it will probably take a century to get to the escalation committee. Every time we ask for feedback we are just ignored, and this has been going on since November 2022. It's about 7 months our case is with them and there's no clear communication or response forthcoming from them. The below extract is directly from the Ombudsman website, "We provide the insuring public and the short-term industry with a free, efficient and fair dispute resolution mechanism through an alternative dispute resolution process, applying the law and principles of fairness and equity." the words efficient and fairness are used here. In our case there's no efficiency or fairness because they are not doing anything against my insurer who has wasted a lot of our time in this case. Our insurer nor the Ombudsman never reply within stipulated times frames.

An investigation should be held against the Ombudsman as they seem more inefficient than the worst performing public sector entity and the competency of their staff ID very questionable. I believe they we have dropped the ball in terms of keeping me updated. A point of huge concern to me within my complaint and review request is the acceptance by the Ombudsman that it seems that he does not see anything wrong with the employees of the insurer making misrepresentations to the insured and he on the face of it overlooks the misrepresentations by the employees of the insurer alleging in essence that it makes no difference to the complaint. As far as I understand the SAIA code of conduct a member (insurer) must conduct its business in an honest, fair and transparent manner and making misrepresentation to client is the opposite of the aforementioned. The code also requires that adverti*****ts must fairly and accurately represent the product and its key features and risks, or the nature and scope of the service advertised, and advertising must be clear, fair and not misleading thus doing something opposite to your advertised guarantee is against the provisions of the code of conduct, but the Assistant Ombudsman sees nothing wrong with this. In my view the Ombudsman for Short-Term Insurance has a duty and an obligation to ensure that appropriate mechanisms are in place to address the needs of consumers when investigating complaints and complainants are to receive the care, protection, and guidance that they may need however if you officially condone and insurer to act in breach of the provisions of the SAIA code of conduct and dismiss the legitimate complaint of the insured letting the insurer off the hook you have failed to examine the information and evidence placed before you by the parties to a dispute and made a decision that was not guided by the legal position and principles of fairness and equity. From the aforementioned it is clear that this complaint was handled with bias, **************, and/or prejudice toward the complainant and not handled with efficiency. I was not given a provisional report or any feedback and or an opportunity to discuss and possibly resolve my concerns with the Assistant Ombudsman dealing with the matter and despite this he saw it fit to issue a “final” report without even consulting with me on these important issues hence the escalation request. I have tried to be patient and resolve this matter amicably. I have also worked through the correct escalation channels but have only been met with resistance and incompetence. It pains me to say it, but it seems the Ombudsman for Short Term Insurance is yet another failed organization in South Africa that does not care about carrying out their duties. Their office is supposed to assist where the insurer has acted incorrectly or unfairly against an insurance consumer and financial loss has been suffered but it seems overcharging clients after 6 months where premiums are guaranteed for 12 months is not something they are interested to address nor misrepresentations by the employees of the insurer that premiums will decrease each year as a result of depreciation as per long history and then say nothing if the premiums are increased by 25% as they seemingly do noy understand the concept of vicarious liability.