Explanatory notes on insurer statistics

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    Notes

    1. The data must be understood in the correct context and it is therefore necessary to record some words of explanation in relation to these statistics.
    2. The office of the Ombudsman has limited jurisdiction over commercial lines policies and, in any event, has jurisdiction for personal lines business only up to R3,5 million, save for home owner claims where the jurisdictional limit is R6,5 million. The statistics therefore focus only on personal lines claims (statistics provided by the Financial Sector Conduct Authority (“FSCA”)) and personal lines complaints received by this office. Commercial lines complaints, which are not reflected in the statistics, represent about 8% of the total complaints to the office of the Ombudsman.
    3. Also excluded from the insurer statistics are those complaints resolved “on transfer”. In terms of the complaints handling process that came into effect on 1 January 2019, an insurer is given an opportunity to resolve a complaint directly with the insured where the insured lodged a complaint with OSTI before first approaching his/her insurer to resolve the complaint. This process is referred to as the “on transfer” process. If the insurer resolves the complaint to the satisfaction of the insured, then the decision of the insurer is not recorded as an overturn against the insurer in these statistics but is included in the overall office statistics. Further comments on the overturn rate appear below.
    4. No adverse conclusions should be drawn against any insurer based purely on the number of complaints against them received by this office. Larger insurers issue proportionately more policies which cannot form the basis of a complaint to this office due to our jurisdictional limits. Thus, for example, when considering the percentage of complaints received by this office against a large insurer, the large insurer, upon a superficial analysis, therefore appears to attract a relatively low number of complaints. What is the more important statistic is the proportion of personal lines complaints relative to an insurer’s share of the total personal lines claims reported to the FSCA. The clearest indicator of this is column 5, being the number of complaints to this office per thousand claims received by an insurer. Where an insurer receives a high number of complaints to this office per thousand claims, this may be an indicator that claims are dealt with unfairly by the insurer. However, this statistic should be considered in conjunction with columns 8 and 9, being the share of matters resolved through conciliation by the parties/enforcement by OSTI. The overturn rate is an indicator that the decision of the insurer with respect to a complaint was changed in some respect by this office with some additional benefit to the insured. Further comments on the overturn rate appear below.
    5. Please note that a claim can be received by an insurer in year one and a complaint in respect of that claim may be received by OSTI only in year two – hence the number in column 1 may be greater than the number in column 3. The statistics record the numbers received by insurers and the OSTI respectively during 2019.
    6. Also note that under column 1, certain insurers may be shown by the FSCA statistics as having received no claims during 2019. This may be explained on the basis of either the company issuing only commercial lines policies or that the company is dormant. We repeat that only personal lines statistics are included in the table as this is what has been received from the FSCA. (columns 1 and 2)
    7. The overturn rate per insurer as shown in the table is for personal lines claims only. It excludes commercial lines claims and complaints resolved on transfer (see point 3 above). 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. 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 the Ombudsman’s office from a particular insurer in resolving a complaint to the satisfaction of the customer. The Ombudsman takes into account the following two circumstances in determining the Overturn Rate:
      1. The decision of the insurer is overturned by the Ombudsman by way of a recommendation which is accepted or by way of a Final Ruling.
      2. A resolution of the dispute has been mediated by the Ombudsman with the insured receiving a benefit which he/she would not have received without the involvement of the Ombudsman.
    8. Any media queries in relation to the insurer statistics should be directed to the particular insurer.
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