In life, we try to minimize the risk, and that often means taking different insurance policies, whether it’s a life cover to make sure your loved ones are taken care of or to insure the vehicle to make sure there are measures in place when involved in a car accident or a victim of car theft.
While one or all of these policies should provide you with peace of mind, it does not necessarily mean that you will receive a remuneration if you apply. Year after year, thousands of South Africans are left frustrated after insurance claims are either partially or entirely rejected.
We take a look at some of the main reasons why your insurance claim might be rejected and how the law is on your side if you should feel as though you were being mistreated by an insurance company.
When filling out the insurance application form, you must be as transparent and honest as possible. Any details that may be inaccurate or facts that were misrepresented could lead to legal action against you for insurance fraud. It may be worthwhile to add statements or images that support your claim.
Only insure your belongings
Technically, you are not allowed to secure property or objects that you do not own or use. For example, many parents will insure their children’s vehicles according to their policies because it usually works out cheaper.
Most companies prefer it if children have their policies, especially when they earn their own income and are financially independent. So, while it may be a bit of an administrative nightmare, it is best to separate the policies so that there are no unnecessary obstacles when it comes to applying. If your children are not financially independent and drive your vehicle, make sure you list them as nominated drivers.
Unlicensed or unspecified drivers
Some policies only cover the ordinary driver, so if someone else drives your vehicle, you have to specify correctly who will use it. Also, if the car is involved in an accident while being driven by a driver without a license, the application will be rejected.
Remember that insurance premiums are based on the risk profile of the driver, so any misrepresentation of the driver’s details – or those details not being updated – could be the reason why the insurer rejects the claim.
Drive responsibly and abide by the law
Your insurance policy contains a portion which refers to reckless driving. This means that if you were driving recklessly, the insurer might refuse to pay your claim. There is also a road traffic violation clause, so if, for example, you were speeding at the time of the accident, your claim could be rejected. Of course, if you are involved in an accident while driving under the influence of alcohol, your application will not be paid.
Also relevant here is the illegal leaving of the accident site. The legislation provides that a driver involved in an accident in which a person or animal is killed or injured, or any property (including another vehicle) is damaged, must stop the vehicle to ascertain the extent of any damage or injury suffered and reported the accident to the police department within 24 hours of the accident (unless prevented from doing so due to an injury). Failure to do so could be grounds for rejecting the request.
Mostly, you want to avoid any negligence and including leaving the keys in the car or not activating the alarm in the house, for example. It is also wise to install a tracking device and get proof that you have one if your car is stolen.
Make sure your monthly premiums are up to date
If your payments are overdue, you will give up any coverage from the insurer, and your insurance claim will fail. However, if you are struggling to pay your premium, contact your insurer and see if there is an alternative payment arrangement that will keep your coverage intact.
One of the main reasons why applications are rejected is because of unpaid premiums. The good news is that, by law, insurers are required to have a clause in their policy that gives consumers a grace period to pay the overdue premium. This period may not be less than 15 days, but it may be longer, so check your policy. Whatever the case may be, ensuring that payments are made on time and a regular basis is the best way to avoid problems.
Claiming during waiting periods
Almost every insurance policy has a waiting period before any benefits can be obtained or claimed. Your insurance claim will be rejected if it falls within this time frame.
Read the fine print and identify any exclusion
Whether it is car insurance or life insurance, each policy has specific exclusions (things you do not cover) that can be found in terms and conditions. For example, if you remove life insurance coverage, you are unlikely to be granted pre-existing conditions. Make time to read the fine print and make sure you get the comprehensive coverage you need.
Can the law help me if my insurance claim is unfairly rejected?
Of course, if you feel that you have taken all necessary steps and precautions and your insurance claim is rejected, you can call the law for assistance.
We all know that life is going crazy, that the pressures are coming to us, and that we are frustrated on the roads. Acceleration, call while driving, and the need to cope with an increasing number of drivers who disregard the rules of the road are overwhelming. But always keep in mind the financial consequences if your insurance claim is rejected because of your actions.
A professional broker can add extraordinary value to the process and guide you to a complete understanding of the terms and conditions of your coverage and responsibilities as part of a two-way contract with the Insurer.