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Watch out for these pitfalls in South African insurance claims

Watch out for these pitfalls in South African insurance claims

Having insurance for unexpected expenses is the responsible thing to do. However, knowing exactly what you are covered for and what your obligations are in terms of an insurance policy is even more important.

Being unfamiliar with the contents of insurance cover, failing to provide the information required, or altering the information required often sees dedicated insurance premium payers lose out on the benefits of cover.

Understand your policy

As a policy holder, it is in your own interest to make the effort to understand the policy and complete the claims process accurately and in full to ensure your right to a fair settlement.

Do your homework upfront. Understanding exactly what is covered in your policy is essential. Don’t wait until you have an accident before you read your policy and find out that you have “submitted the wrong information or claimed unnecessarily for things that you are not covered for”. Know what you are covered for. If you are unsure clarify this with your insurer or even an attorney.

Admitting liability

Policyholders should also not admit liability even if, in their opinion, they are liable.  This is because liability is something that only an insurance or a legal process can decide. Individuals should not take it upon themselves to apportion liability after a car accident for instance. Policyholders will be left in a difficult position legally if they have admitted liability and it turns out, after an insurance or legal process, that they are in fact not liable. Instead, policyholders should merely record all the details of the accident or loss, let concerned parties know that they have cover where relevant, and then leave it to the insurance companies involved to assess the loss, apportion liability and settle costs for damages where applicable.

Move fast 

Pay attention to time periods set out in your policy. Specifically to those related to when cover commences, when premiums are to be paid and when claims have to be filed.

Claims should also be logged quickly, as and when the damage or loss occurs, not days later. Your policy may prescribe a time period within which claims have to be submitted or even have decisions appealed.  In cases of burglary or robbery household contents policyholders should let the police know and get a valid case number. Having a case number can, in the long run, save policyholders a lot of money by adding to the accuracy, validity and efficiency of the claims and recovery process.

Keep records

It is important to get as much of the right information at the time and scene of the accident. It is understandable that after an accident, burglary or robbery people are very stressed, often forgetting things, failing to write down information like times, places, registration, licence or identity numbers.

Technology can help you. These days it makes much more sense to simply take a picture on a cell phone of the cars and registration numbers involved, as well as the required license cards and the identity numbers. This only takes a few seconds and even if you are shaken up and forget things, you’ll always have the photographs to refer to on your phone.

Honesty is the best policy

Regardless of how you collect and report the information required for the claims process, honesty remains the best policy.

Lies, inconsistencies, different persons, differing versions of the same incident, items not mentioned in the policy but claimed, are very easy to spot and lead to a number of claims being repudiated. Criminal proceedings can be instituted against you by an insurer where there is sufficient evidence of dishonesty and you can be charged with fraud.

Need advice on your insurance matter?

If you need assistance with an insurance matter, where a claim has been denied, rejected or repudiated feel free to contact us at Paul du Plessis Attorneys on 012 809 1588 or send an e-mail to paul@pauldup.co.za