The role of the Insurance Ombudsman schemes
The Ombudsman for Short-Term Insurance (OSTI) and Ombudsman for Long-Term Insurance (OLTI) are independent bodies that clients can contact if they dissatisfied with the outcome of their claims.
In addition to handling complaints relating to the outcome of claims, clients can also escalate matters relating to poor service, misleading communication, or dissatisfaction with their policy or product offering to the relevant Ombudsman.
The Ombudsman’s role is to facilitate dispute resolution between the insurer and the client by acting as a mediator. The office of the OSTI or OLTI will examine the information and evidence sent to them by both parties involved in the dispute and will make a recommendation based on their findings. In the event that the relevant Ombudsman finds in favour of the client the insurer is legally bound to abide by the ruling.
The service is free to consumers and provides a cost-effective alternative to those who may not have the financial means to take legal action.
The value of the OSTI and OLTI Annual Report to the consumer
The OSTI and OLTI publish an annual report that summarises the number of complaints received within a year period. The report also includes a breakdown of the type of complaints received as well as the number of complaints received per insurer.
- Firstly, how often clients complain about a specific insurer
The referral rate shows the number of complaints submitted to the OSTI, per thousand claims received by the insurer. This is a good indicator of the frequency at which clients complain about a specific insurer.
- Secondly, whether the Ombudsman agrees or disagrees with the insurer’s decision
The resolved ratio indicates what the proportion of the complaints finalised were, with some benefit given to the complainant. This metric best indicates the accuracy of the insurer’s claims decisions and client service.
While OSTI and OLTI share the number of complaints that were resolved with some benefit to the complainant (i.e. resolved ratio), OSTI also details the number of short-term insurance claims received per insurer, as well as the complaints received by OSTI per thousand claims received per insurer (i.e. the referral rate).
Click here to download the 2022 OSTI/OLTI report.