How to Avoid Your Insurance Claim Getting Rejected

In life, we try to minimise risk as much as possible, and that often means taking out various insurance policies, whether it is life cover to ensure your loved ones are looked after, or vehicle insurance to make sure that there are measures in place to help you should you be involved in a road accident or fall victim to car theft, for instance. In short, we rely on an insurance claim to lessen financial and emotional strain.

And while having one or all of these policies in place should give you peace of mind, it doesn’t necessarily mean that you will get a pay-out should you submit a claim. Year after year, thousands of South African are left frustrated after their insurance claims are either partially or completely rejected.

We take a look at some of the main reasons why your insurance claim could be rejected, and how the law is on your side should you feel as though you are treated unjustly by an insurance company.

  1. Honesty is the best policy – be clear, concise in your insurance application form

When completing your insurance claim form, you must be as clear and honest as possible. Any details that might be inaccurate or facts that have been misrepresented could potentially lead to legal action against you for insurance fraud. It might be worth adding any affidavits or images that support your claim.

  1. Only insure assets that belong to you

Technically, you are not allowed to insure assets or belongings that you don’t own or use.  For example, many parents will insure their children’s vehicle under their own policies because it usually works out cheaper.

Most companies actually prefer it if the children have their own policies, especially when they are earning their own income and financially independent. So, while it might be somewhat of an administrative nightmare, it’s best to have separate the policies so that there aren’t unnecessary hurdles when it comes to submitting a claim. If your children aren’t financially independent and drive your vehicle, make sure you list them as nominated drivers.

  1. Drive responsibly and abide by the law

Be sure that your driver’s licence has expired and that anyone who drives your vehicle has a licence because should there be an accident, this could result in your claim being rejected because you are technically driving illegally.

Similarly, you must ensure your car is roadworthy- whether it is a worn tyre tread or faulty indicator, your claim could get vetoed if a mechanism or feature isn’t working the way it is meant to.  Of course, it goes without saying that driving under the influence is a no-go.

  1. Mitigate the risk -stay vigilant and be aware

Essentially, you want to avoid any kind of negligence and, and that includes leaving keys in your car or not activating your house alarm, for instance. It’s also wise to install a tracking device and obtain proof that you have one in case your car is stolen.

  1. Make sure your monthly premiums are up to date

If your payments are in arrears, you will forfeit any cover from your insurer and your insurance claim will be unsuccessful. However, if you are struggling to pay your premium, contact your insurer and see if there isn’t an alternative payment arrangement that will still keep your cover intact.

  1. You try to claim within the waiting period

Almost every insurance policy has a waiting period before any benefits kick in or claims can be made.  Needless to say, your insurance claim will be rejected if it falls within this timeframe.

  1. Read the fine print and identify any exclusions

Whether it is car or life insurance, every policy has certain exclusions (things they don’t cover) that can be found in the terms and conditions. For example, if you take out life insurance cover, it’s unlikely that you will be covered for pre-existing conditions.  Take the time to read the fine print and make sure you get the comprehensive cover you need.

Can the law help if my insurance claim is unfairly rejected?

Of course, if you feel as though you’ve take all the necessary steps and precautions and your insurance claim is rejected, you can turn to the law for assistance. You can approach the Ombudsman for Short-Term Insurance for assistance, but there are certain steps you should follow before doing so.

  • Be sure to raise your complaint with your insurance company first. It’s best to do this in writing so that you have a clear record of all the facts leading up to this point.
  • While it may be difficult to control your emotions, try to remain calm and friendly. It will help you communicate effectively.
  • Try to take up the issue with one of the insurance company’s Senior Officials.
  • Keep track of all communication and facts, and make copies of any correspondence.

If you are still unsuccessful, you can lodge a complaint with the Ombudsman for Short-Term Insurance. The Ombudsman functions as an impartial mediator or arbitrator without representing either the consumer or the insurance companies in South Africa. Good news:  filing this complaint won’t cost you a cent.

You can either complete the complaint form by hand and post or fax it or complete the complaint form online and post or fax it. Visit the website of the Ombudsman for Short Term Insurance for more information.

Do note:  you usually only have 6 months after your claim has been repudiated to take the company to court and institute a civil claim.