From pillar to post

Has the Ombuds really created a solution for South African consumers, or has this Office just become another unhelpful paper depository as dissatisfied consumers are sent from pillar to post ?

About three weeks ago I phoned one of South Africa's largest banks to question some rather dubious homeowners' insurance policy transactions. My bank had 'written' an insurance policy against a building loan in error. After explaining my concern to the call centre operator it became apparent that for my problem to be adequately handled I'd have to climb significantly higher on the 'skills' ladder. But the call centre agent refused to escalate my call.

Upon asking what I should do to further my complaint I was told in no uncertain terms that I should take the issue to the Insurance Ombudsman. Huh ? I was absolutely stumped* Why would the bank's call centre offer this solution before making even the slightest attempt to resolve the matter internally ? I doubt my experience is unique...

Astounding arrogance

This encounter highlights the astounding arrogance of the insurance industry in this country when dealing with consumer complaints.

Let's say, hypothetically, that I am an average consumer, who has little or no idea what the complaint process should be at the office of the insurer or the Ombud, never mind the legal recourse open to me. In fact, I have a full-time job, a family to support and many restrictions on my time that prevent me from, for example, spending several hours on the phone or compiling comprehensive complaint documents.

The next pillar...

But, now my insurer has told me to take my complaint to the Ombud. In what little time I have available, I phone the Ombud. Guess what? I do not receive the assistance I am looking for. No, this interaction is just another time-consuming exercise producing no results, as the Ombud's office tells me without hesitation: "You must complain to the Insurance Company first, before we can look at your complaint."

...and back to the dreaded post

And by "complain", they don't mean make another phone call and complain bitterly. No, they have a list of hints to assist consumers to complain "effectively" to the insurer. So it's back to the dreaded call centre, and I duly keep a note of the person's name, date and time of the call and what was said, also adhering to the Ombud's Hint No 2: "Remain calm and polite, however emotional, angry or upset you may be."

Since I cannot get past the call centre agent, I have to ask for the insurer's complaint procedure and try to speak to a Senior Officer (venture a guess how easy it is to find these elusive people with non-descript job titles!) without phoning the listed number, which goes through to the call centre.

When is enough, enough ?

Next, I have to write a letter, which must be faxed to no-one in particular and then...wait. If I don't receive a reply, I have to keep sending the letter, since the only way to find out if the letter has been received would be to call the call centre operator, who does not sit near the fax machine and has never met anyone in the company who knows where the fax machine is.

By this time, I feel that I have suffered enough to approach the Ombud again. Armed with notes containing dates, names and conversation details, I ask the Ombud for help again. Guess what! There is a long list of instances in which the Ombud cannot assist me, neatly listed on the website:

* Road Accident personal injury or death claims
* Cases which involve other people's insurers, but not your own
* Cases where attorneys are already involved, particularly when legal action is already pending
* Cases which only relate to alleged rudeness, inefficiency, negligence or bad-quality service, unless this has resulted in an actual financial claim against a broker, or involves repudiation of a claim
* Cases where an insurer has cancelled your insurance, but there is no claim pending or repudiated under the policy
* Cases where you are simply wanting general legal advice on Insurance Law without having to pay for it
* Disputes between repairers or renovators and the public, unless the contention is that your insurer is responsible for them, and not you.

Commercial or business insurance complaints will only be dealt with where it involves a sole proprietor or trader, a juristic person or partnership that had a turnover in the last financial year of less than R8 million. In addition, only the following commercial insurance complaints may be dealt with are Fire and Allied Perils (not if Loss of Profits or Business Interruption cover is involved), Glass, Theft, Motor, Travel, Sickness and Accident, and SASRIA claims affiliated to the aforesaid covers.

Not there yet

Even if I do manage to squeeze my complaint into a category that is covered, I am still advised to first visit another pillar and another post first, just for good measure.

Says the Ombud's website: "If you are not happy with the insurer's decision you may:

1. Issue a summons out of the Small Claims Court (there is a small cost involved) on the Insurance Company. The maximum amount that can be claimed in the Small Claims Court is R7000.

2. Consult with an Attorney to pursue the matter by means of further legal action.

3. We may be able to help. You will need to fill in our complaint form and send it back to us."

Point 2 is particularly concerning in light of the fact that the list of instances in which the Ombud cannot assist consumers specifically includes: "Cases where attorneys are already involved, particularly when legal action is already pending".

So, if I followed the options as set out, I would disqualify myself from the Ombud's assistance, before I even get to their very vague, uninviting and long-awaited "We may be able to help."

The long road to the end

Do not get hopeful just yet. Lodging your complaint means completing a form, attaching your supporting documentation and submitting it to the Ombudsman. The supporting documents you need include your letter of declinature, your policy schedule or certificate of insurance and details of you correspondence with the insurer. You then have to provide an outline of the complaint and what you expect the Ombudsman to do.
Once you've submitted the form the Ombudsman will correspond with the insurer to establish the facts of the case... back to the call centre ?

And while it has taken the average consumer several weeks, if not months to get here, it will take the Ombudsman more than three months, on average, to resolve the case – if, of course, your complaint is found to have merit.

Job, the bulldog ?

The Ombudsman has handled more than 22 026 disputes – and they've 'won' back R196 million for wronged policyholders over the last three years. Good for those policyholders, since they had to have the patience of Job and the determination of a bull dog to make it so far!

You have a right to be heard. If the insurance companies force you to play hard ball to enjoy that right, well, best of luck! The astounding arrogance in the insurance industry will ensure you visit many a pillar and post for the rare chance of being one of the lucky few the Ombudsman could help.