As with most ombudsman reports, the number of claims it receives about each company is reflective of that company\u2019s 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.<\/p>\n
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.<\/p>\n
To give a better idea of service levels, the report includes another metric to better gauge the scale of claims \u2013 a figure showing how many claims are received per 1,000 customers an insurer has.<\/p>\n
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.<\/p>\n
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.<\/p>\n
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.<\/p>\n
In terms of successful claims, 16% of claims finalised by the OSTI ended with some form of benefit for clients.<\/p>\n
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.<\/p>\n
Overturn rates<\/strong><\/p>\n 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.<\/p>\n \u201cIf 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,\u201d it said.<\/p>\n \u201cHowever, 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.\u201d<\/p>\n The rates below include both circumstances covered by the OSTI \u2013 where claims were finalised in favour of the client through conciliation with the insurer, and as a result of ombud action.<\/p>\n
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