Guiding consumers since 2009

Want your insurance claims paid out? Be honest, then

By Staff Writer

It’s a given that consumers expect insurers to process their claims quickly, without too much hassle and, of course, pay out these claims. The question to ask is what can be done to speed up the process and ensure a payout when a policyholder suffers a loss?  The answer: In a discussion where the questions asked and answered is based on good faith and will form the basis of the contract - accurate information is vital.

One of the most common disagreements between insurers and their clients happens at claim-stage due to “incomplete disclosure”. A substantial number of claims rejected are as a result of the non-disclosure or partial disclosure of information that has an effect on the way an insurer rates prospective customers. MiWay’s view on this thorny subject is that an informed, educated customer will ultimately make for a less-risky customer to insure. By explaining the importance of accurate info and the effect this will have on a customer’s premium and potential claims, is vitally important to not only ensure that we rate a customer accurately but also to avoid upsetting customers at claim stage.

Accurate information about the object insured, the usage thereof – such as business use or private use – ensures a quicker and easier conclusion of the claims process.  Clients need to understand that most questions asked at underwriting stage will play a role in determining the premium and acceptance of the risk.  It is therefore extremely important to ask for clarification if a specific question is not understood. Having streamlined claims processes, structured client communication during the claim and world class follow-up procedures are all ways of making the claims process more efficiently and quicker.

Policyholders have to be educated about the repercussions and short sightedness of under-insurance. Under-insurance of home contents, especially in tough economic environments, becomes very tempting and often leads to claims not being honoured 100% by insurers. Clients should carefully consider the replacement value of the items rather than the perceived current value. Ask your insurer about items with higher than average value such as engagement rings, art collections and so forth. Lastly, if clients are still unsure about the value of the items in their home, remember to also consider the unobvious items such as clothing, curtains and cutlery, and ask for an inventory form to check these items against.

A very important fact to emphasise:  Over-claiming for a few extra CDs or a bigger TV is considered insurance fraud!

Honesty is ALWAYS the best policy and the insurance industry has a no tolerance for fraudulent claims. MiWay is no different.  We continue to see that consumers seem unaware of the fact that fraudulent claims and dishonest actions will not only affect current claims, but will also have an effect on all future insurance intcaeractions – including premium and claims with other insurers. Insurance fraud is a criminal offence.

At MiWay we are in the business of managing people’s risks and would like to encourage consumers to understand this process – your monthly premium is based on the perceived risk of loss or damage to your assets. Here is where your personal profile, i.e. where you live and how you manage your risks and assets, will affect your premium. We aim to educate consumers at pre-sales, sales stage and after-sales stage rather than have upset or unhappy clients that resent the insurer and don’t trust the process.

Approximately three years ago, a body known as The South African Insurance Crime Bureau (SAICB) was established. They focus on insurance fraud and collaborate with the law enforcement entities in order to manage fraud within the industry by studying shared information from insurers in order to prevent insurance fraud.

In closure, here are some pointers to assist consumers to keep their insurance information as correct as possible:

Once the sale is completed and you receive your policy documents (which by law needs to be furnish to you within 30 days from date of sale) – spend the time to go through them thoroughly to ensure that all the information noted there is correct

If there is any incorrect information, please notify your insurer immediately

Should anything relating to your financial situation (i.e. judgements, debt review, liquidations or sequestrations) change – notify your insurer immediately

Should you move residence, notify your insurer of your new risk address prior to moving

When you buy new goods for your home – amend your sum insured immediately

Always note the correct regular driver of the insured vehicle.  Putting yourself on as the regular driver when your child is driving the car in order to save on premium is dishonest behaviour and could result in a claim being rejected.

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