How to ensure that your insurance claim is paid out

When it comes to insurance claim repudiations, negative perceptions are common amongst consumers in South Africa. The repudiation of a claim is often a worry for many insured individuals, although, according to CIB Insurance Administrators (CIB), if an insurance policy is correctly structured and updated accordingly, repudiations should not be a concern.

While not a frequent occurrence, repudiations are an unavoidable occurrence in the industry, and can occur when consumers do not comply with the terms and conditions of a policy. According to Michelle Hancock, head of the claims division at CIB, this often takes place out of pure ignorance.

In order to dispel the negative perceptions that have been created over the years, as well as educate consumers, Hancock says that brokers need to advise their clients accordingly. “For the consumer, a professional broker’s advice is truly invaluable when the issue of an insurance claim arises.”

“Consumers need to stay informed and updated with regards to insurance policy wordings and schedules in order to avoid repudiations. In addition, the insured should also read all the correspondence from their broker or insurer, as the most critical changes will usually be highlighted in the covering letter. If clarification is needed, consumers should ensure that all queries are directed to their broker,” says Hancock.

She advises that when insuring high value items such as cameras, jewellery or art, consumers should forward their broker a copy of the purchase invoice or evaluation, so that it can be kept on file. “This will speed up the claim process and ensure that the damaged or stolen item is replaced.”

According to Hancock, a common misconception is that all policies include cell phones and laptops under the household content cover. “These items are not included in the policy and therefore need to be specified. Also ensure that all technology upgrades are communicated to your broker.”

Hancock has the following tips to prevent claim repudiations:

· Ensure that all insurance premiums are paid and up to date. Missing one month’s payment could result in a claim being denied. All the previous months’ insurance premiums will not accumulate to cover the missed month.

· Any material change or change of address should be communicated to a broker within 30 days. A claim will not necessarily be paid out if the insured fails to do so.

· Policy holders should ensure that insured vehicles have been fitted with the necessary security or anti-theft features as requested by the insurance company. These devices should also be checked on a regular basis.

· The roadworthiness of the insured vehicle should be checked on a regular basis. Accidents that occur because of, for example, smooth tyres orworn shocks, might not be covered in the event of a claim.

· If possible, photos should be taken at the accident scene to assist with the description and extent of the damages.

· Alarms need to be tested on a quarterly basis. It is the insured’s responsibility to ensure that the response company is receiving a signal.