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When can I not be helped?

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In what instances can the Ombudsman for Short-Term Insurance not help me?

As a service to the public, the Ombudsman will always reply to insurance-related enquiries if he can and he may suggest a course of action informally where he cannot act formally as Ombudsman. In particular, he cannot formally deal with:

  1. Road Accident personal injury or death claims.
  2. Commercial or Business insurances
    • Kindly note that we can now deal with Commercial or Business insurance disputes on a limited basis, including a sole proprietor or trader, a juristic person, partnership that had a turnover in the last financial year of less than R10 million.  Only the following commercial insurance complaints may be dealt with by this office:
    • Fire and Allied Perils (if there is an involvement of loss of profits / business interruption, the entire complaint will not be dealt with by this office).
      • Glass 
      • Theft 
      • Motor
      • Travel 
      • Sickness and Accident
      • SASRIA Claims (affiliated to the aforesaid covers)
  3. Cases which involve other people's insurers but not your own.
  4. Cases where litigation against the insurer has already commenced.
  5. Cases which only relate to alleged rudeness, inefficiency, negligence or bad-quality service, unless this has resulted in an actual financial claim/ loss or involves the rejection of a claim.
    • Kindly note that with the passing of the FAIS Act 37 of 2002, complaints against intermediaries/brokers are to be dealt with by the FAIS Ombud whose further contact details can be obtained from his website: www.faisombud.co.za
  6. Cases where an Insurer has cancelled your insurance, but there is no claim pending or repudiated under the policy.
  7. Cases where you are simply wanting general legal advice on Insurance Law without having to pay for it!
  8. Contractual disputes between insurers and brokers, or between brokers and sub-brokers.
  9. Disputes between repairers or renovators and the public, unless the contention is that your insurer is responsible for them and not you.

In addition, where there is in fact a rejected claim, but the amount involved or in dispute is less than R15 000, always consider the alternative of the Small Claims Court where you can take action without legal costs, and probably achieve a result much more quickly than by using the Ombudsman's services. If you don't know how to use the Small Claims Court, your Attorney (or the Ombudsman) will tell you how to go about it. Even if your claim is over R15 000, consider abandoning the amount in excess of R15 000 in order to bring the amount within the Court's jurisdiction.