The Role of Insurance Ombudsman

An insurance policy is nothing but an agreement between two parties i.e. the insuring policy provider and the insurance policy holder. The agreement or contract details the responsibilities of both the parties involved in case an incident occurs.

While insurance policies are extremely beneficial for the policy holders, sometimes they can be too complex for both the parties to agree on everything. These are situations where disagreements between the insurance policy holder and the insurance policy provider arise.

The insurance ombudsman is appointed for dealing with these disagreements between insurance policy providers and their customers. The objective of the insurance ombudsman, for both short term and long term insurance policies, is to resolve the discord in the most just, economical, and unbiased manner.

The insurance ombudsman can mediate between policy providers and holders for a wide variety of insurance fields. Some of the areas in which the insurance ombudsman can mediate include automobile insurance, home and house owner insurance, travel insurance, and many others.

A very important aspect of the insurance ombudsman is that his services are free for all individuals who have an insurance policy in South Africa. Moreover, the ruling of insurance ombudsman in the disagreement between the policy holder and policy provider is binding on the latter but not on the former.

The process of availing the services of an insurance ombudsman is fairly simple and easy as well. If you have a disagreement with your insurance policy provider and are looking for a way out, the following step by step process to get help from an insurance ombudsman should be useful to you.

1. The first step is for you to informally notify the insurance ombudsman of your situation. If the disagreement is within his purview, you would receive an application form with a reference number. If it is not, then he would still send you an email explaining the situation.

2. Once you have filled the formal application form out and sent it back to the insurance ombudsman, you will get an acknowledgment and the ombudsman will contact your policy provider. The case will now be studied in detail by the insurance ombudsman through various documents and transcripts.

3. Moreover, the insurance ombudsman will also solicit comments and responses from either your insurance policy provider or your insurance broker. During the entire process, the insurance ombudsman is ensuring that the complaint is valid and falls under his purview.

4. Depending upon the situation, the insurance ombudsman will either make a ruling or arrange a meeting between the insurance policy holder and insurance policy provider to come to a mutually suitable agreement.

5. There are various legal and technical issues involved in most cases that go to the insurance ombudsman. Moreover, the ombudsman is obliged to be as thorough and detailed as is possible with each complaint. The result is that each complaint or application takes a lot of time to be processed.

6. In addition to this, it should be noted that in complaints where the disagreement is based on facts then the insurance ombudsman is within his rights to decline a ruling either way.

The purpose of an insurance ombudsman is to resolve as many disputes between policy holders and policy providers as possible so as to keep these cases from going to the court of law.

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