Why your insurer may not pay out your claim

By Nicolette Mashile Time of article published Nov 1, 2021

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NICOLETTE’S NICKELS

By Nicolette Mashile

Taking care of your health, personal items, business, and life in general should be a top priority. Insurance is not just a luxury; it is a necessity. You never know when you may be in an emergency – life tends to just happen, and you will need to have a safety net in place, just in case.

Taking out a policy now could save your life in the future. But you do not just find an insurer, and it stops there. You still need to be responsible for it, or else your insurer will not pay out when you have a claim. There are many reasons for this – below are just a few of the important ones.

A month ago, a friend of mine was involved in a car accident. When she called me to come out and assist her, my first question was whether or not she was okay and not injured. I was not too bothered with the car. It is a material object – after all, that can be replaced. Of course, it comes with a cost implication, hence why we take out insurance to mitigate any financial loss. On arriving on the scene, I asked her if she had logged the accident with the insurance. She shyly whispered: "I don't have insurance on the car, friend."

"You don't have insurance, what do you mean?" I asked in disbelief.

"Well, I had, but I stopped paying them, so I don't think they will help me," she said to my horror.

Missed premiums

One of the most common reasons your insurer will not pay out is that your premiums are not up to date. Yes, you could set it as a debit order, but some circumstances can prevent that debit order from going through, such as insufficient funds in your account, you being retrenched from work, or your account being hacked. If your insurer does not receive your payment, they should notify you and give you 30 days to make the missed payment. If you continue to ignore your payments, they may reject your claim or even end your policy.

Unregistered driver/ unroadworthy vehicle

Specifically for vehicle insurance, if your car is involved in an accident and the person driving the vehicle was not the registered driver in the policy, it is likely the insurer will not pay out your claim for damages. If you decide to be in the Uber business as an additional income stream and hire someone to drive your vehicle while you are at work, you will need to give the driver's details to the insurer to always protect your vehicle.

Since we are talking about cars, note that a vehicle that is not fit for being on the road will also be rejected for payout. If your car shows any signs of damage, such as the windscreen being cracked, the engine faulty, the lights not working, or even the seatbelt not working, the insurer may reject the payout. When taking out the policy, do a vehicle inspection to ensure that it ticks all the boxes for being roadworthy.

Medical conditions

Specifically for life insurance, if you have a terminal illness or any medical conditions with no cure and it is confirmed that your lifespan may not go over 12 months, then your insurer may not cover you. On the other hand, if your policy's timeline ends and you have outlived your policy, you may not receive the payout either. If you are unsure about your health conditions and need life insurance, first consult an adviser about the policy terms and your rights before signing the dotted lines.

Non-disclosure

Your insurer will not pay out if you make a claim for something that they should have been aware of but were not. The action of not disclosing essential information to your insurer, whether through intent or ignorance, may result in claims being repudiated. Take a chronic illness, for instance, like diabetes, a high-risk hobby like deep-sea diving or a dangerous job like routinely being on a scaffold – these are things that your insurer needs to know of when you take out the policy. By entering an insurance contract, both parties have to be honest with each other.

Finally

Now that you know the reasons for insurers not paying your claim, you can take the correct measures to prevent that. Pay your premiums. When filling in your application, do not feel shy to answer the question thoroughly and truthfully. When there are changes in your life, immediately discuss them with your insurer to make alternative arrangements to your policy.

If ever you have issues with your claim being rejected, you may request that the insurer escalate the matter internally for review and if that doesn't work, take it to the relevant Ombudsman to assist you with your case.

PERSONAL FINANCE

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