Insuring one’s property be it personal, a vehicle or a home, ensures that one can protect the people and the things you own and value when mishaps, accidents and unforeseen or unplanned events occur. But sometimes when a calamity does occur, then even with an insurance policy in place, a claim that one thought would be covered does not go as smoothly as one had expected.
If you lodge a claim with your insurance company and it’s rejected, does this mean the end of the road? Not always. Below are some steps you can take to escalate the issue and hopefully get a more favourable outcome.
Check the Policy wording- always be sure that what you’re claiming for is covered in your policy document and that exclusions that may be mentioned do not apply. Contact your insurance broker or insurer directly for clarification – if you have an insurance broker then seek clarification or alternatively contact the call centre of the insurer to let them know that you’re unhappy and wish to dispute the rejection of the claim. All insurance companies are required by law to have a formal complaints process, so follow this process to get the best possible outcome and resolution.
Follow the Dispute Resolution Process of the Insurer. Usually, there is a dispute resolution process provided on the insurer’s website, so be sure to check for such before contacting the call centre. In most cases, a written complaint is best for accurate record keeping and ensuring that the facts are stated clearly and concisely. If you do phone a call centre ensure that you record the details of the conversation: the name of the person you spoke to, what was said, the date and time of the call, and a reference number should always be asked for. Stick to the facts and try not to get emotional. Try to remain neutral and stay calm: being objective even if you’re upset or angry means you’ll be understood more easily, which can hopefully resolve the matter quickly. Before you call make sure you write down the facts chronologically so that your complaint will be conveyed and recorded in a clear and logical order. Make sure you include relevant details like your claim number and the insurance policy number.
Try to get an independent assessment. Once you have the specific reason for the claim being rejected from the insurer, preferably in writing, it is a good option to try and find an external party who can provide an objective point of view. This may be a professional consultant or a contractor, but preferably an independent loss-adjustor who should be able look at the damage and its cause objectively, and then provide a written report to yourself that you can give to the insurer as part of the dispute resolution process. The cost of such an inspection is usually for the insured’s account.
Approach the Short-term Ombudsman. If all else fails and one still feels aggrieved, then the insured can take their complaint to the Ombudsman for Short-Term Insurance. The Ombudsman is a free, independent service that investigates complaints from ordinary people towards insurance companies. They consider all the evidence of the complaint in an objective manner to reach an outcome, that is hopefully fair to both the insured and the insurer. In South Africa, the short-term ombudsman (www.osti.co.za) deals with car, homeowner, and householder insurance complaints. There is a complaint form to be filled out and sent to them, along with supporting documentation about the nature of your complaint, the history behind the complaint, and the redress you are seeking. The ombud will then approach the insurer for their input, and finally after consideration of the facts as presented, the ombudsman will inform both parties of their decision.
Legal advice can still be sought if one is still not satisfied.
If your insurance claim is rejected, try following the steps provided above, as it may mean a better outcome, especially for your pocket.
