Information Regulator report recommends release of insurance claims data

The Information Regulator (IR) has recommended the release of more than 47 000 records.

The Information Regulator (IR) has recommended the release of more than 47 000 records.

Published Aug 15, 2024

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The Information Regulator (IR) has recommended the release of more than 47 000 records from the National Financial Ombud Scheme (NFOSA) following a complaint over a lack of transparency.

The complaint was lodged by Independent Bureau of Forensic Investigation (IBF)’s, Stan Bezuidenhout ‒ a freelance journalist, filmmaker and forensic expert in crash reconstruction ‒ in August last year after NFOSA denied access to the information relating to insurance claim repudiation complaints.

The IR investigated the matter and after completing its investigations, findings and recommendations were made to the enforcement committee who will now consider the recommendations.

The 47 535 records the IR has recommended be released relate to 9 799 total complaints received in 2018, 10 376 received in 2019, 14 198 in 2020, and 13 162 during 2021.

According to the IR report, NFOSA relied on sections of the Promotion of Access to Information Act (PAIA) to deny IBF’s request.

The report, in part, found that the head of NFOSA “failed to justify how the requested records in a format requested by the complainant would breach the agreement with a third party in that the information requested is not required to disclose any personal details as it is statistical in nature”.

IR spokesperson, Nomzamo Zondi, confirmed the matter is now with the enforcement committee and a final ruling is pending.

“We have completed the investigation and a preliminary investigation report was issued with recommendations and findings which is now before the Enforcement Committee for their consideration. The Enforcement Committee is yet to determine the recommendation made in the preliminary report which proposes for the body to release the records to the requester,” said Zondi.

Enquiries to NFOSA were not answered by deadline.

According to Bezuidenhout, his complaint stemmed from a “dramatic rise in insurance claim repudiations, where insurers reject claims for various reasons”.

According to the IR report, clients described interactions with the ombudsman as one who “acted as a guardian for the insurance industry, rather than as an impartial arbiter”.

In preparation of a media report aimed at informing the public about how NFOSA handles complaints, Bezuidenhout had sought access to the statistical information about the number of complaints submitted to the NFOSA, the way in which such complaints were handled, the number of complaints closed, and the outcomes of those complaints, including such statistical information per participant.

Bezuidenhout’s report would focus on potential biases in favour of insurers and how this might affect insured individuals' decisions when choosing between approaching the Ombudsman or to pursue legal action.

The IR noted that the information sought fall under rule 14.2 of the NFO Rules, which provides that “the NFO must also publish at least on an annual basis”, which means it should be automatically available and noted it is statistical data which is anonymised and does not constitute confidential information.

“The Ombudsman’s office adopted a confrontational stance, refusing to answer my questions and invoking legal representation to discourage further engagement. This response only heightened my concerns and those of my clients, leading me to seek more concrete evidence of potential bias,” said Bezuidenhout.

Bezuidenhout said the IR feedback marks a significant victory for transparency and accountability within the insurance industry.

“It underscores the importance of ensuring that consumer protection bodies operate with the highest degree of impartiality and public trust. I extend my highest praise and gratitude to the office of the Information Regulator for their unwavering professionalism, commitment, and thoroughness throughout this process. Their efforts have been instrumental in upholding the public’s right to information and ensuring that the principles of justice and fairness prevail.”

Cape Times