The main reasons why insurers will deny your claims

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Insurance cover is not a guarantee that your claim will be paid out, and insurers have the right to deny a claim under certain circumstances, says Wilma van der Walt, executive of customer experience and operations at PPS Short-Term Insurance.

Below she outlined how to ensure your vehicle and home claims are paid out as a policyholder.


Transparency

When you apply for short term insurance, try to be as transparent and honest as possible, said van der Walt.

“Supply as much information as possible and let the insurer decide what is relevant and irrelevant. For example, you need to be transparent about including your previous insurance claims history.

“Also understand the difference between personal and business use when it comes to your car. Using your car to drive to and from work is still classified as personal use.”

However, if you are using your car to visit clients regularly or you have to use your vehicle to deliver goods – that would be classified as business use, she said.

“Don’t be tempted to specify personal use if you know you use your car for what would be classified as business use.”


Who is in the driving seat?

Your insurer will ask you who the regular driver of the car will be. In other words, who will be driving the car most of the time? If you and your spouse often share the driving, let your insurer know, said van der Walt.

“Some insurers are happy to pay out a claim as long as the driver behind the wheel is licensed. However, some policies stipulate a “regular driver”.

“If this is the case and you have not specified your child, husband or wife as a driver, then your claim could be rejected.  If you have a young driver in your household, make sure you mention this to your insurer.”

Van der Walt said that insurers usually charge an additional excess fee (the first amount payable before your claim is paid out) for drivers under 25 but if you have not declared this or are dishonest about who was driving the car when you make a claim, the insurer can decline your claim.


Stay up to date with your premiums

In terms of the Short-Term Insurance Act, you are entitled to a 15-day grace period within which to pay your premiums.

If you have financial constraints and need to skip a payment, call your insurer to advise – most insurers will offer to pause your cover or make a note that you are making a late payment.


Roadworthiness

Mitigate the risk of an accident by ensuring your car is always in a roadworthy condition. One of the most common problems related to this is the condition of your tyres.

“Smooth tyres impact on your braking distance and affect your car’s roadholding ability. Overinflated tyres result in the tyre wearing in the centre, giving you a harsher ride and reducing the tread life of your tyre.

“An underinflated tyre, on the other hand, also reduces tread life significantly with tyres wearing more on the outside shoulder. Underinflated tyres mean that the tyres flex more, causing internal heat leading to tyre damage from overheating or worse, a blow-out.”


Exercise due care

As the policyholder, you have a responsibility to exercise due care, said van der Walt.

“This means that you as the policy holder should always try and minimise or prevent a loss, this includes incidents such as leaving your keys in your car or not activating your house alarm.”


Maintain your goods

While your insurer does accept risk for unforeseen events, you are expected to maintain your home and keep it in good condition, said van der Walt.

“For example, you should regularly have your gutters cleaned or check that your roof tiles are clean and in good condition.

“If, for example, a heavy thunderstorm results in a portion of your roof caving in but the reason for the build-up of pressure is blocked gutters and lack of maintenance on your roof, your insurer can decline the claim on the grounds that you failed to properly maintain your home.”

Finally, read and understand your policy, both in terms of what is covered and what is excluded, she said.

“While your insurance provider must explain the policy terms and conditions, the onus is on you to ensure that all the captured details are correct and to ask questions if you don’t understand anything or you are unsure of any details.”

Main Image: Ammonslaw

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