This link will open the complaints data from the Ombudsman for Short-term Insurance’s 2023 annual report.
The statistics in the table focus only on personal lines claims (as provided by the FSCA) and personal lines complaints received by the OSTI.
The OSTI has limited jurisdiction over commercial lines policies and has jurisdiction over personal lines business up to R5 million, except for homeowners’ claims, where the jurisdictional limit is R10m.
As the OSTI points out, no adverse conclusions should be drawn against an insurer based purely on the number of complaints against it received by the OSTI.
Larger insurers issue proportionately more policies that cannot form the basis of a complaint to the OSTI because of its jurisdictional limits. Thus, for example, when considering the percentage of complaints received against a large insurer, the large insurer, upon a superficial analysis, appears to attract a relatively low number of complaints.
In the OSTI’s view, the 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, which shows the number of complaints per thousand claims received by an insurer.
Where an insurer receives a high number of complaints per thousand claims, this may indicate that the insurer dealt with claims unfairly. However, this statistic should be considered in conjunction with columns 8 and 9, which show the share of matters resolved through conciliation by the parties/enforcement by the OSTI.
Some key take-outs
The table shows that the OSTI received 10 228 complaints (2022: 10 044), and insurers received more than 5.5 million claims (2022: 4.8 million) – in other words, complaints did not even constitute 0.5% of claims.
On average, there were 1.856 complaints (2022: 2.070) per 1 000 claims received by insurers. Of the 55 insurers listed, 29, or 52.7%, had a complaint rate higher than this.
Of the 8 885 (2022: 8 553) complaints finalised, 13% or 1 168 (2022: 1 329) were finalised with some benefit to the insured.
As was the case in 2022 and 2021, Santam Structured Insurance had the highest complaint rate, at 12.943 complaints per 1 000 claims (2022: 13.216 complaints per 1 000 claims; 2021: 12.6 per 1 000). It received 27 659 claims (2022: 25 196; 2021: 20 875), and the OSTI received 358 complaints about it (2022: 333; 2021: 263).
As was the case in 2022, the OSTI received the highest number of complaints about Old Mutual Insure, at 998, in 2023. However, this was a decrease from the 1 179 in 2022. Old Mutual’s complaint rate was 4.740 per 1 000 claims (2022: 5.863 per 1 000).
As in 2022 and 2021, Centriq received the highest number of claims, at 942 081 (2022: 462 063; 2021: 417 567), in 2023. This was 17.09% of the total claims (2022: 9.52%; 2021: 9.8%). Once again, Centriq had a below-average complaint rate of 0.159 complaints per 1 000 claims (2022: 0.346 per 1 000).
Claims and complaints data
Column 1 may show certain insurers as having received no claims during 2023. This may be because the company issues only commercial lines policies or the company is dormant.
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. Therefore, the number in column 1 may be greater than the number in column 3.
Overturn rate
The overturn rate is an indicator that an insurer’s decision with respect to a complaint was changed in some respect by the OSTI, with some additional benefit to the insured.
The overturn rate per insurer excludes commercial lines claims and complaints resolved “on transfer”.
An insurer is given an opportunity to resolve a complaint directly with the insured where the insured lodged a complaint with the OSTI before first approaching his or her insurer to resolve the complaint. This process is referred to as “on transfer”.
If the insurer resolves the complaint to the satisfaction of the insured, the insurer’s decision is not recorded as an overturn against the insurer in the table.
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 because a high overturn rate can also indicate a high degree of co-operation received by the OSTI from an insurer in resolving a complaint to the satisfaction of the customer.
The OSTI considers the following two circumstances in determining the overturn rate:
- The decision of the insurer is overturned by the OSTI by way of a recommendation that is accepted or by way of a ruling.
- A resolution of the dispute has been mediated by the OSTI, with the insured receiving a benefit that he or she would not have received without the involvement of the OSTI.
Further notes
- The statistics for Old Mutual Insure include statistics for Iwyze.
- The statistics for Centriq include statistics for Shoprite Insurance Company.
- Telesure Investment Holdings took over Renasa’s OSTI complaints with effect from 1 July 2023.
- Mutual and Federal Risk Financing’s name changed to Old Mutual Alternative Risk Transfer Limited (OMART) in December 2023.
I would love to see a segmentation of how many of these claims were made up of direct vs intermediated business in future with relevant context provided.
Hi Heerin. Yes, that would be an interesting stat. Surely direct business will have a higher % of claims.