Dishonest Insurance Claim: Materiality

Donald Dinnie, Norton Rose Fulbright

The insured instituted a claim against the respondent insurer for payment of the replacement value of his stolen motor vehicle. The claim was rejected by the insurer, who alleged that the insured had supplied it with dishonest information when making the claim.

The insured alleged that he had given a lift to two women and had stopped to purchase food along the way. The insured does not have any recollection of events that unfolded after that. He was awoken the next morning by unknown individuals in an unknown location without his vehicle, cell phone, keys, and wallet. His evidence was that he was dizzy. He managed to return home and then went to the police station to open a case of theft of his motor vehicle. He suspected that the women had drugged him.

The insured cooperated with the insurer in its assessment and verification of his claim. The insurer later alleged that the insured had provided dishonest information and rejected his claim

It was never disputed that the insured had provided information to Miway that, at a later stage, was found to be incorrect. This information related to whether he dropped the two women off before or after he lost consciousness; where the alcoholic beverage was in his vehicle; and the time he left the social event. The trial court found the insured to have acted fraudulently and dismissed his claim.

However, on appeal, the court noted that Miway’s pleaded case was that the claim had been “dishonest” and fraud was not alleged. The trial court therefore misdirected itself in considering fraud. The appeal court considered whether the discrepancies in the insured’s information was so material and prejudicial to Miway that it entitled Miway to reject the claim. On the evidence, the court concluded that the insured’s vehicle had been stolen.

The court stated that the test is that, to the extent that there was any dishonesty or discrepancies in the insured’s version, it must be material to Miway’s obligation to indemnify him for the claim to be rejected.  Miway did not lead any evidence establishing how and on what basis it was allegedly prejudiced. The court concluded that the discrepancies in the insured’s information were not material at all, and the insurer was ordered to pay his claim.

Molefe v Miway Insurance Company Ltd [2023] ZAGPPHC 2238; A189/2022 (20 June 2023)

First published by: Financial Institutions Legal Snapshot