Insurance
When you have paid your insurance premiums and suffer a loss, you expect your insurance company to act in good faith and to reimburse your loss. Unfortunately, too often insurance companies refuse to pay, or pay only some of the loss, offering very technical and sometimes unreasonable excuses.
Experienced and specialised legal advice is essential to assess whether the insurer has correctly rejected or computed the value of a claim.
In most cases, there is a limited time within which to act on an insurance dispute, so you should get legal advice as soon as possible after receiving notice of the insurer’s stance rejection or computation.
We are proud of our distinguished 27-year history of providing sage advice and producing excellent results for clients from all over South Africa.
If you think your insurance claim is being unfairly handled, rejected or computed, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Fire Damage and Business Interruption
Fires can cause devastating destruction. Losses as a result may be covered by various provisions in an insurance policy.
The effects of a fire will vary from one business to the next depending on what caused the fire, where the fire started, accelerants and materials in affected and surrounding areas, the type of business involved. In some cases, the fire may be contained, affecting only a portion, while in others the entire business may be completely destroyed. Personnel and or clients may be injured or killed, vehicles destroyed, adjacent buildings may catch alight. In many instances, businesses will suffer loss of profits for the period of closure.
A business insurance policy will have provisions which cater for different aspects of the loss, depending on how and what has been affected. It may be that although physical damage is restored, loss of profits are not. Any unmet claim may have a significant impact on the financial health or survival of a business.
Some examples of reasons for repudiation include misrepresentation, fraud, non-disclosure of a material fact and failure to meet a warranty. The event or loss may also be specifically excluded in the policy. Disputes may arise in the computation of the loss (see also Business Interruption).
Whether the insurer’s claim rejection or computation is valid (and will be upheld by a court), or not will depend on the specific facts and the interpretation of the insurance policy.
If you think your fire claim is being unfairly handled, rejected or computed, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Disability Claims:
Disability insurance covers individuals for lost income caused by a disability.
There are different types of disability policies. Depending on the specific type of cover taken out, a policy may include partial or temporary disability, or on the other hand only pay when there is total permanent loss of work capacity. Some policies provide occupation-specific cover for when a qualified individual is unable to continue working in the qualified field (although may still be able to work in another occupation).
Reasons for rejection of a claim under a disability policy include misrepresentation, fraud, non-disclosure of a material fact, that the disability is the result of a non-insured or excluded event or is the result of a pre-existing condition which has been specifically excluded from cover.
Whether the insurer’s rejection or repudiation is valid (and will be upheld by a court) will depend on the specific facts and the interpretation of the insurance policy.
If you think your disability claim is being unfairly handled or rejected, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
If you think your disability claim is being mis-handled or has been rejected unfairly, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
All Risks:
All risks cover is designed to insure against loss which occurs in any one of many different scenarios and which may not be included under the general provisions of a policy.
As an example, where a valuable item is included generally under a homeowners or business policy would be covered (subject to an overall value limit) in the event of theft or damage when on the property of the home or business, may be excluded if damaged at another place. Under an all risks policy, the item or risk is specified and a premium paid for the cover of damage to the item, irrespective of where it is or the circumstances of the loss (all risks).
Although all risks generally means all risks, there are a few exceptions. These include:
- Exclusions which are specifically stated in the policy.
- Practical limits which exist due to the nature of the type of insurance and risk insured against.
- Legal limitations, including that the loss must be accidental and lawful to insure.
Reasons for rejection of a claim under an all risks policy may include misrepresentation, fraud, non-disclosure of a material fact or that the loss is the result of a non-insured or excluded event. A very technical reason for rejection, called inherent vice involves that the item or peril insured against is such that by its very nature the insured item was likely to be damaged or lost.
If you think your claim is being mis-handled or has been rejected unfairly, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Business Interruption
Most business insurance policies include cover for losses due to the interruption of the operation of a business due to an insured event, such as a fire, storm or other property damage. If cyber protection is included and the business has been brought to a halt due to cyber-attacks, business interruption may also be applicable. If a business is affected by civil commotion or public disorder, strikes, riots or terrorism, such losses may be covered under Sasria insurance. Recently, businesses have successfully claimed for their losses as a result of the covid-19 outbreak and resultant lockdowns.
Factors that will affect the computation of a business interruption claim are the indemnity period, gross profit and the business’ performance over the preceding 12 months, external factors that may affect business performance over the indemnity period and adequate insurance (average).
Reasons for the rejection or partial rejection of business interruptions claim may include that the cause of the business interruption wasn’t an event covered in the policy, misrepresentation, fraud, non-disclosure of a material fact, failure to meet a warranty, that external factors would have caused the business not to have generated the claimed amount of profit or that the business was underinsured and that a pro-rata amount is paid (average).
If a loss is the result of civil commotion or public disorder, strikes, riots or terrorism, this may be excluded from the cover as it should be insured under Sasria cover. If the business does not have cover against such an event, it may be that the broker has negligently failed to obtain Sasria cover and may be liable.
A common dispute in business interruption claims involves computation of the loss of profits.
Whether the insurer’s rejection or computation is correct (and will be upheld by a court) or not will depend on the specific facts and the interpretation of the insurance policy.
If you think your business interruption claim is being unfairly handled, rejected or computed, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Death Claims:
Life insurance involves the payment of a lump sum in the event of the death of the life insured.
It is common for life policies to provide cover for illness or accidental death, which implies that non-accidental death (such as for example suicide or an intentional act with a great risk of death) would be excluded.
Reasons for rejection of a claim under a life policy may include misrepresentation, fraud, non-disclosure of a material fact (for example that the life-insured was suffering from a terminal or life-threatening condition at the time of taking out the policy, that the death is the result of a non-insured or excluded event or is the result of a pre-existing condition which has been specifically excluded from cover.
If you think your death claim is being mis-handled or has been rejected unfairly, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
SASRIA:
Sasria provides special risk cover to individuals and businesses that own assets in South Africa, as well as government entities. This is unique cover against risks such as civil commotion, public disorder, strikes, riots and terrorism.
Most commercial insurance policies exclude losses due to the type of events covered by Sasria cover. It is vital that the broker ensures that Sasria cover is in place.
Reasons for disputes in Sasria claims include improper computation of the loss of profits or that the event which caused the loss isn’t covered – because it doesn’t fall under the definition of civil commotion, public disorder, strikes, riots and terrorism.
If you think your Sasria claim is being mis-handled or has been unfairly rejected or computed, or that your broker has slipped up in not securing Sasria cover, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Limited time to Claim:
Most insurance policies contain a clause which stipulates that you have a limited amount of time (90 days, 180 days, depending on your policy) from the date on which you were given notice of the rejection of your claim to take steps to enforce your claim.
It is very important that you don’t delay in obtaining advice on whether you have been treated unfairly or not and whether you should start legal proceedings to avoid your claim lapsing.
If you think your claim has unfairly rejected or computed, contact us at +27 (0)12 809 1588, via our contact us request form or send us an email at paul@pauldup.co.za and we’ll contact you.
Our Process
We will ask you to provide us with a detailed history of the facts giving rise to the claim and the reasons why you believe that you have been treated unfairly, the claim form and your insurance policy.
Once we have had a chance to go through the detail of your dispute, we will provide with advice on whether we think you have been treated unfairly or not and how the matter should be taken forward.