Life is filled with uncertainty and often throws us curveballs. While we can’t prevent the unexpected from happening, we can take out various insurance policies to minimise everyday risks and safeguard our finances. From vehicle and household insurance to income protection and life insurance, having one or all these insurance policies in place should give some peace of mind. Being covered doesn’t necessarily mean that a pay-out is guaranteed should you submit a claim. Year after year, thousands of South African are left frustrated after their insurance claims are either partially or entirely denied. But, there are things you can do to avoid having your insurance claim rejected and steps you can take to dispute repudiation.

Tips to Avoid Having Your Insurance Claim Rejected:

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

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

2. 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 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.

3. 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. After all, 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.

4. 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.

5. Make sure your monthly premiums are up to date.

If your insurance premiums 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.

6. Be aware of waiting periods.

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

7. Read the fine print and identify any exclusions.

Every insurance policy has specific 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 coverage you need.

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

If you feel as though you’ve taken all the necessary steps to avoid having your insurance claim rejected, and your claim is still repudiated, you can turn to the Ombudsman for Short-Term Insurance for assistance. Still, 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, 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 make copies of any correspondence.

If you are still unsuccessful, you can complain with the Ombudsman, who functions as an impartial mediator or arbitrator without representing either the consumer or the insurer. 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 six months after your claim has been repudiated to take the company to court and institute a civil claim.

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