Getting insurance cover for one’s assets is commonly seen
by many as a grudge purchase, and as much as some customers might not
enjoy paying their monthly premiums, the good news is that they’re assured that
their assets are well covered (within the limits of the policy wording) to face
the worst of unforeseen circumstances.
Very few people read through the fine print in their
insurance contracts, which differs significantly between policies and insurers.
In some instances, it’s only when they need to submit a claim, that they learn
about a missed clause that they have not adhered to or an exclusion, resulting
in a possible rejected claim.
Claim rejections happen and often
leave the customer feeling dissatisfied and cheated. As a customer you
have the right to request the reasons for rejection from the insurer and either
approach the insurer’s internal arbitrator or take it further by approaching
the Ombudsman for Short Term Insurance to counter the rejection.
Often, claims are rejected for valid
reasons, and it is unfortunate that in some cases, the customer has
misinterpreted the cover and exclusions or failed to comply with the terms and
conditions. Where you feel the rejection is not warranted, obtain a
second opinion to validate your claim and present this evidence to your
insurer.
Below are 10 things customers need to
keep in order, to ensure that their claims are approved:
. Wear
and Tear – This is where items have a life span and once that time has
been reached, it breaks or no longer works effectively. This is not
covered by the policy and is noted as an exclusion. For example,
buildings need to have water proofing on the roof, as they’re exposed to sun
and harsh weather conditions, these generally perish after 2 years. If
your roof leaks following a storm, due to this wear and tear, your policy will
not cover the water proofing. Depending on your policy wording, the
resultant damage may or may not be covered.
· Maintenance
– This is general upkeep of your property or items. Failure to do
this will result in a rejection as this is a specific exclusion. For
example, tree roots cause damage to pipes, drains, paving, walls or your motor vehicle
must be serviced annually.
·
Defective workmanship/
materials used – This is specifically excluded. For
example, the contractor builds a wall, fails to follow South African building
regulations or mixes the building materials incorrectly and the wall collapses.
· No
cover – This is where an incident has occurred, but the policy does
not provide the cover for this event. Events that are commonly
insured are fire, wind, storm, hail, theft but some events may/may not be
included such as accidental damage and power surge. A claim for
accidental cover, where this has not been selected, will result in ’no cover’.
· Non-Disclosure
– Failure to notify your broker or insurer of relevant changes that may
increase the risk of acceptance for the policy to respond to may result in your
claim being rejected. For example, a tenant occupies your property which you
have disclosed. After a couple of months, the tenant moves out of your
property and is vacant (no signs of anyone living there by way of visiting the
premises, lack of furniture). This change in risk has not been disclosed.
Should vagrants move in or damages are caused to the property, this could
result in a rejection of your claim.
· Late
notification – The insured has 30 days to report a potential claim to
the insurer/broker. Failure to do so may prejudice the insurer’s
ability to assess the claim and result in a rejection.
· No
insurable interest – The interests of all parties must be noted on the
policy for their respective rights and interests to be covered. If
you do not have financial interest in an asset, you cannot insure
it. For example, your friend’s car is registered in her name, but
you are insuring it on your policy without notifying your insurer/broker of the
insurable interests.
· Unpaid
premiums – If you place a stop order on your short-term insurance
debit, this will result in an immediate cancellation and no cover will exist as
your intention was not to pay the premium. If your debit order
returns due to lack of funds, you are required in terms of legislation
and your policy wording to pay this outstanding amount before the insurer will
consider the claim.
· Misrepresentation,
dishonest or criminal behaviour – All these could draw serious
consequences for the Insured, to the extent that they could be blacklisted and
may not be able to obtain insurance.
· Avoidance
of cover – In the event of fraud, misdescription, misrepresentation or
non-disclosure of material facts, the insurer could cancel the policy with
immediate effect or declare the policy null and void from inception date,
resulting in the claim being rejected.
In
order to avoid a situation where your claim could be rejected, it is important
to familiarise yourself with the above-mentioned reasons, but also make sure
that the terms and conditions are reviewed regularly. Following the claims
procedures, complying with the time limitations and taking the necessary steps
to avoid a loss are some of the important steps you can follow if you want
your claim to be settled.
“It is
extremely important to understand your insurance contract and claim parameters.
Every policy sets out your obligations in the event of a claim. This includes
the time period within which a claim must be reported to the police and your
insurer, what information you must provide to your insurer, as well as the time
frame within which to dispute the outcome of a claim
For a quotation or assistance with your
Short-Term Insurance needs, please contact our office on the following methods:
* Phone 031-5021922
* What’s app 0824508720
* Website www.esbrokers.co.za
Article source: FNB Private Wealth, written by Elizabeth
Mountjoy