Claiming insurance for damages associated with environmental factors

Recent extreme weather, including sustained torrential rains in many parts of the country, has left a trail of devastation. Besides the loss of human life and agricultural produce, the severe weather has worsened the fragile infrastructure of our roads.

Consequently, excessive potholes and uneven surfaces have become the biggest bugbear for motorists on South African roads, leaving them out of pocket because of the tyre, wheel suspension and other related damages.

Linked to this is the impact of the heavy rains and hailstorms on properties. We have seen how homes and warehouses were washed away in KwaZulu-Natal not so long ago. Insurance policyholders are concerned about whether they are covered for such natural disasters.

Regarding claims where potholes are involve, we have seen several companies that sold tyre cover as a standalone policy have stopped doing so. The only conclusion we can draw from this is that due to the ever-increasing potholes and other surface hazards on our roads, the underwriting of such policies became too onerous and expensive to continue offering cover. Some insurers apply a limit to the cover amount per claim with a number of incidents per year limit. For example, the maximum amount the insurer will pay per tyre is R3 000 with a limit of twice a year.

Companies will also apply betterment on the tyre claims. Betterment means that the tyre was used for some time before the incident. If 40% of the tyre tread is left, the insurer will deduct 60% from the settlement amount for the tread the client had used. This is why the client needs to read their policy carefully to know what they are covered for.

It is the insured’s responsibility to ensure that when submitting a pothole-related claim, the damage is not as a result of wear and tear. It is equally important to ensure that vehicle maintenance is undertaken regularly as this helps to identify where possible road damage may have occurred without the owner’s knowledge.

If a motorist does not claim from their insurance, they can either claim from the municipality, the provincial government or SANRAL in the case of national roads (such as the N1, N2 and N3). However, it is prohibited to claim from the insurer and the other entities for the same incident.

When claiming from SANRAL or the relevant municipality, the claimant will have to prove that the damage was caused by a specific pothole in the relevant area of the municipality, for example, submitting photographs and a police affidavit.

Regarding buildings, common causes for claims are damage caused by wind, rain and hailstorms. As much as these can, indeed, cause significant damage, one of the first questions an insurer will ask is whether the property was properly maintained. As in the case of maintaining a vehicle, the same would apply when submitting a claim for building damage. Regular property and building maintenance by a professional services company are is advisable as this facilitates the processing of claims where environmental elements have caused damage.

Whether a client claims from an insurance company for weather/nature-related damage to a car or any other property, the insurer may decline the claim if it can prove that damage to the asset was due to wear and tear or a lack of maintenance. Clients should, therefore, always ensure that their cars and property are adequately maintained at all times.