These are the four big fights between insurers and clients – and here’s how to get your claim paid out

Business Insider SA
  • Driving under the influence is a big reason for disputes between policyholders and insurers, according to the annual report of the Ombudsman for Short-Term Insurance.
  • In 2017, a large number of complaints about policies were also related to storm damage. 
  • Top tip: Don't keep records of your priciest belongings on your property. 

The 2017 annual report of the Ombudsman for Short-Term Insurance, which has just been released, shows that car claims represent almost half of the 10,000 complaints the ombud handled last year. Some 75% of these claims were for accidents.

These are the four crucial warnings from the report:

1. Don’t ever drink and drive.

Photo: ER24

Drunk driving has emerged as the biggest battleground between insurance companies and their clients. Most of the car accidents claims considered by the ombud were rejected because the insured was driving under the influence of alcohol.

“Some insurance companies have introduced measures such as the ‘take me home’ service to manage the risk associated with drunken driving,” says the ombud’s office.

“However, it is clear from this year’s statistics that DUI remains a very real problem for the South African insurance industry.”

2. Don’t neglect your house, and keep records of all property maintenance.

Tornado damage to a police station in the Vaal Marina Photo: Felix Dlangamandla

In 2017, a large number of disputes were about storm damage. Following the tornadoes in the Vaal area, flash floods in Gauteng and KwaZulu-Natal, fires in Knysna and the extreme drought in the Western Cape, 13% of all complaints were due to claims following natural events.

The biggest problem was when insurers refused to pay out claims on the grounds that the damage was due to gradual deterioration, a lack of maintenance, and wear and tear.

“In general, the Ombudsman will assess these matters by asking whether the loss or damage would have occurred if the property had been properly maintained. If it clearly would have occurred even if the property had been adequately maintained the Ombudsman will usually uphold the claim,” according to the report.

3. Keep proof of your most expensive belongings outside your home.

The biggest number of complaints about household content claims are about how much the insurer was willing to pay out.

In many of these claims, the insured was unable to prove ownership and the value of the goods.

It is reasonable and necessary for the insurer to request proof of ownership when validating a claim, particularly with high value items, says the ombud. Policyholders should keep an inventory of their home contents and retain proof of ownership. Important: keep copies of receipts and valuation certificates outside your home, so that these are not also taken during a burglary or destroyed in a fire.

4. Don’t ever bend the truth when you apply for car insurance.

A large cause for rejected vehicle claims is “misrepresentation” about who the regular driver of a car is, says the ombud. Also, your claim will be rejected if you lied about your claims history, credit history, security devices and whether the vehicle would be used for personal or business use.  


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