Guiding consumers since 2009

Advice to claiming from insurance properly

By Staff Writer

The latest ‘briefcase’ from the Ombud for Short Term Insurance (OSTI) has been released, highlighting insurance claims stories, and some general tips for consumers.

Justmoney looks at the top three stories highlighted by the OSTI, and gives an opinion on the cases too.

Case 1:

Submitting false documents

Ms S, who was insured with King Price Insurance, was robbed at gunpoint in her home, and various items were stolen.

She then lodged a claim with King Price for the stolen items, and provided photographs.

Among these photos, Ms S set a picture of an X-Box, similar to the one which had been stolen, but which belonged to a third party, explained the Ombud.

The insurer pointed this out to Ms S, because the photo had a date stamp on it, which was after the robbery had occurred.

Ms S told the insurer that it was her understanding that the photo should be a representation of the item stolen, and not the actual one – as that would be impossible to obtain.

Ms S also provided proof of purchase for the X-Box to King Price.

There was another issue with the claim, as a GPS was also stolen, but there were two different versions of where the item was stolen from.

Ms S’s son said it had been stolen from his mother’s vehicle, but Ms S said it was stolen from the house.

Due to this, and the photograph discrepancy, the insurer rejected the claim.

Ombud’s findings

The insurer was reminded by the Ombud that, after such a traumatizing event, victims could not always be expected to remember specific details of events, such as where things where stolen from.

The Ombud also said that Ms S was not trying to claim for an X-Box that she did not have, but rather to highlight what the X-Box did look like.

Due to this, the Ombud found no evidence of fraud taking place, and recommended that the insurer pay Ms S out in full, to which they did.

Justmoney’s opinion

Always remember to keep all documents when it comes to insurance claims. If you are going to buy a new TV, gaming console, or anything that you are going to insure, keep the receipts.

As we can see with Ms S’s case, if she did not have the proof of receipt, the outcome may have been very different.

Also make sure that you update your insurer to new items you would like to have insured, or if something has changed in terms of your home contents, your home, or your vehicle, so that at claims stage, there is no confusion.

Case 2:

Disclosing all information to insurer

Mr V, who had been using his premises as a guesthouse, had since placed it on the market to sell, and told his insurer – Absa insurance – that one of his employees was staying there during the evenings.

There was a loss to the property. However, the insurer rejected the claim due to the fact that the employee only stayed on the premises during the week nights, and not on the weekends – something which Mr V had not told the insurer.

Furthermore, Absa Insurance believed that the property had an active alarm system, as stated in Mr V’s policy. However, the property did not have a compliant alarm system in place at the time of the incident.

Though, Mr V argued that the insurer had been informed of the changes in risk, and that they were still prepared to insure the property.

He also highlighted that the alarm warranty been in place when he sought contents cover, which had then been cancelled.
According to Mr V the alarm was not applicable to the building section of the policy.

Ombud findings

The Ombud found that Absa Insurance was in the right to reject the claim. This was because, even though Mr V did tell the insurer about some of the changes in risk, he did not fully disclose all the changes.

Justmoney’s opinion

You should always let your insurer know when there are changes to your risk, or to your home in any way, as with the first case.

Because Mr V did not tell his insurer of all the changes that had been made, the insurance company was not fully aware of the circumstances to which they would still be insuring him.

It is better to give your insurer all the facts.

Case 3:

Diving under the influence

Auto & General Insurance rejected a claim for damages to Mr G’s vehicle, due to the fact that he was driving under the influence of alcohol.

Mr G argued that he had attended a function, where he had one glass of wine, he then had a nap, and after that went out to purchase food, when the accident happened.

The evidence which Auto & General relied upon was that of the truck driver, and the SAPS arresting officer, both who confirmed that they could smell alcohol on Mr G’s breath.

They also said that he could not talk properly, and was uncooperative.

Ombud’s findings

Mr G was charged with drinking under the influence of alcohol, but had said that the criminal charge had been struck off the roll, and therefore he had been acquitted of the charge.

The Ombud concluded that the insurer’s rejection of the claim was right.

According to the policy a blood test and breathalyser test is not required so the insurer had the right to take the police officer’s word that the driver was under the influence. 

Justmoney’s opinion

Never drive while drinking. Even if you have had only one glass, rather be safe and ask someone to drive for you, or take a taxi home.

Mr G should not have been behind the wheel, especially if both the SAPS officer and the truck driver said that he could not talk properly.

If you do not feel well, or have been drinking, do not put your life, and the live’s of others in danger.
 
 

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