An insurance claim. Picture: File picture: IOL
An insurance claim. Picture: File picture: IOL

Decoding the claims process: Your questions answered

By Opinion Time of article published May 18, 2021

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By: Karabo Kopeka

Few would argue the fundamental necessity of a comprehensive insurance policy, given South Africa's consistently high crime levels and the well-documented dangers faced on our roads. While many motorists and homeowners have elected to protect their valuables with relevant insurance policies, it is essential that every policyholder knows their obligations when lodging a claim to ensure a satisfactory outcome.

So how do you ensure that your next claim is a successful one? Get started by familiarising yourself with the answers to these frequently asked questions:

Q: I was involved in an accident having lost control of my vehicle. Can my claim be rejected on the basis of my tyre tread?

A: Your obligation to your insurer doesn't end with your signature. In order to maintain the validity of your cover, it's important to keep your vehicle in a roadworthy state. Worn tyres can significantly compromise your ability to navigate wet roads, thus elevating your risk profile and your chances of losing control. The legal limit for tyre tread in South Africa is 1mm, which also applies to your spare tyre, which should also be kept in a roadworthy state. Deterred by the high costs of tyres, many motorists tend to delay the inevitable and necessary replacement thereof. However, this short-term saving could cost you dearly at a later stage, resulting not only in a rejected claim, but also in an accident that could otherwise have possibly been avoided.

Q: I sold my car privately and never received payment. Why was my claim for theft rejected?

A: In order to justify a claim relating to theft, it's important to prove that you acted responsibly and took all necessary measures to prevent said theft from occurring. For instance, if you elected to sell your vehicle privately and delivered it to the new owner – be warned that an SMS isn't considered sufficient as a proof of payment. Make sure that the funds reflect in your bank account and are available for you to withdraw before handing over your vehicle. It’s vital that you consult the terms of your contract before embarking on a private sale and risking serious financial loss. Equally, should your car be stolen or ransacked as a result of negligence on your part – for example if you forgot to lock the vehicle or left valuable items in plain sight – your claim could be compromised. Remember, insurance isn't an invitation to act irresponsibly, but rather a trust relationship in which both the insured party and the insurer have certain obligations.

Q: My claim was rejected on the basis of non-disclosure of previous losses? What does this mean?

A: Your risk profile is calculated based not only on your current circumstances, but also on your previous loss history. Essentially, if you've been involved in an incident or filed a claim in the past three years, your insurer needs to know about it, as this will influence your monthly premium and the dynamics of your cover. Failing to disclose an accident upfront – even if you never filed a claim thereafter – could jeopardise the success of any future claims, as you would have essentially been covered based on an incorrect risk profile.

Q: My claim was rejected due to non-payment of my policy, even though I had a good reason. Am I not covered even if I miss one monthly payment?

A: Insurance isn't something you can switch on and off as needed. If you find yourself unable to make a monthly payment for any reason, it's important to let your insurer know ahead of time. In such cases, provisions can potentially be made, but should you simply cancel your debit order or fail to make funds available without notifying your insurer, your cover will be considered null-and-void. Should you file a claim having failed to make your monthly payments, it's highly likely that it will be unsuccessful.

Q: I filed a claim two months after an accident only to have it rejected? Is there a time frame in which I need to claim?

A: If you find yourself the victim of a crime, the onus is on you not only to report the event to the local police, but also to your insurer in a timely manner. This time frame should be stipulated in your contract, so make sure you understand the terms and file your claim in time. Should you fail to report an incident to the authorities, the validity of the claim may also be called into question, as essentially this serves as proof of the event. You will need to justify your claim to make the process more seamless.

Q: I loaned my car to a friend who was then involved in an accident. My claim was rejected on the basis of him not having a valid license - is this justified?

A: As a policyholder, you have an obligation not only to act within the terms of your contract, but also to the letter of the law. As such, if an accident were to occur in which the person driving your car was found to be driving illegally, a successful claim outcome would be unlikely. It's vital to ensure that anyone driving your car is in possession of a valid driver's license. Your insurer is obliged to operate within the bounds of South African law.

Filing a claim should be a simple and stress-free process, provided you're properly informed and compliant with the terms of your policy. In order to increase the likelihood of your claim being paid out, make sure to familiarise yourself with the terms of your contract, and contact your insurer timeously should you for any reason be unable to adhere to the terms listed.

Karabo Kopeka is the Head of Claims at MiWay Insurance

PERSONAL FINANCE

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