The office of the Ombudsman for Short-term Insurance (OSTI) has published its annual report for 2021, showing which insurance companies in South Africa drew the most complaints last year.

In 2021 OSTI closed 10,879 complaints, 0.7% more than in 2020. The OSTI recorded a resolved ratio, also known as an overturn ratio, of 18%, the same as in 2020.

The resolved/overturn ratio is an indicator of those complaints where the insurer’s decision was changed by the office with some additional benefit to the complainant.

According to the ombud, R197 million was returned to insurance customers through the OSTI – mostly going to commercial claims (R134.8 million).

Of the total, R97.7 million relates to Covid-19 business insurance complaints that were settled by the members after the courts handed down their judgments on the causal connection between the government-imposed  Covid-19 lockdown regulations and the interruption to businesses.

“Many of the claims pertaining to these complaints were settled by the members before the office issued a recommendation,” said ombud Edite Teixeira-Mckinon.

The biggest portion of complaints related to motor vehicle insurance, followed by homeowner insurance claims, commercial insurance claims and household content claims.

Most complained-about insurers

As with most ombudsman reports, the number of claims it receives about each company is reflective of that company’s client base. That is to say, a company with more clients is likely to have more claims directed to the OSTI, and the inverse is also true.

The OSTI stressed that just because a company received a lot of complaints, this isn’t necessarily reflective of its services. Big companies that serve a lot of customers will receive more complaints than smaller insurers with a small client base.

To give a better idea of service levels, the report includes another metric to better gauge the scale of claims – a figure showing how many claims are received per 1,000 customers an insurer has.

Beyond this, it also includes data on how many complaints were resolved by the OSTI, and what percentage of the matters were resolved with enforcement orders.

Overall, the ombud tracked 8,384 claims from customers, representing 1.945 claims per 1,000 people who are insured with the listed groups. Of the 54 insurers listed, 24 had a claim rate higher than this.

Santam Structured Insurance had the highest claim rate of 12.6 claims per 1,000 people. Absa Insurance, which had the highest number of claims overall, had a claim rate of 4.2 per 1,000 people.

In terms of successful claims, 16% of claims finalised by the OSTI ended with some form of benefit for clients.

Guardrisk Insurance had the most claims finalised in favour of customers, but 15% of these were resolved through conciliation, and only 0.67% were resolved through enforcement.

Overturn rates

The OSTI noted that the overturn rates (claims finalised in favour of clients) shown are for personal lines claims only. It excludes commercial lines claims and complaints resolved on transfer – claims received by the ombud before going to insurers.

“If a high overturn rate is registered, this may, but not necessarily, indicate that the insurer is not treating its customers as fairly as it should,” it said.

“However, the overturn rate should be treated with considerable caution as a high overturn rate can also be indicative of a high degree of co-operation being received by OSTI from a particular insurer in resolving a complaint to the satisfaction of the customer.”

The rates below include both circumstances covered by the OSTI – where claims were finalised in favour of the client through conciliation with the insurer, and as a result of ombud action.

 

 

Article originally appeared in Business Week