“Know your ombud” episode 5

In the latest episode of our Know Your Ombud series, I am joined by Edite Teixeira-Mckinon, the lead ombud for non-life insurance at the National Financial Ombud.

Have you ever felt overwhelmed or confused by one of your insurance policies? Not sure what is covered and what is not, and unsure of your rights as a consumer when you feel mistreated by your insurer? You’re certainly not alone!

Understanding your rights is very important when it comes to the world of financial services, especially the confusing and complicated world of insurance.

In this conversation, Edite emphasises the importance of understanding the terms and conditions that come with your insurance contracts.

Many consumers assume that paying their premiums automatically guarantees coverage for any loss. But insurance contracts are filled with specific terms that dictate what is covered and what is not.

For eample, did you know that your car’s insured value can significantly impact your claims? Edite explains that many complaints arise from misunderstandings about the insured value of vehicles.

Another aspect is short-fall insurance which covers the difference between what you owe on the car and what it is worth – often this does not include the balloon or residual payment.

Edite notes that car insurance accounts for a significant portion of complaints received by the ombud’s office. This is largely due to the sheer volume of policies sold and the complexities involved in claims processing.

This episode sheds light on the intricacies of insurance claims, including the importance of being aware of the specifics of your policy, such as excesses and exclusions.

Edite highlights the role of the fairness principle when adjudicating complaints. The ombud’s office not only applies the law but also considers fairness and the circumstances surrounding each case.

This is particularly relevant when assessing claims that may be rejected due to breaches of policy terms, such as negligence or recklessness. Edite explains how the ombud navigates these complex situations, ensuring that consumers are treated fairly.

We also chat about the rise in complaints related to household insurance, especially following events like flooding and storms.

Edite shares valuable advice on how to stay informed about policy changes, renewals, and the implications of not understanding your coverage.

The episode serves as a reminder that while insurance can be a safety net, it is crucial to actively engage with your policies and understand your rights as a consumer.

Contact details

If you feel let down by a financial service provider, you can contact the appropriate ombud scheme via the links below:

• Ombud for Financial Services Providers (FAIS Ombud): Disputes related to financial advice
• Office of the Pension Funds Adjudicator (OPFA): Disputes related to pension funds
• JSE Ombud: Disputes related to the JSE
• National Financial Ombud Scheme (NFO): Disputes related to banking, credit, and insurance

This podcast series was created in partnership with The Ombud Council.