Car insurance claims are quite common in South Africa, where accidents and theft are rife. If you have insurance, you would expect your insurer to pay out enough funds to repair or replace your car. However, in some situations, your claim might be denied, or you might receive a smaller payout than you feel is fair.
In this case, you can dispute through the internal disputing channels in the insurance company, or you could contact an Ombudsman. In this blog, we’ll look at your available options and what you can do to ensure you get a reasonable payout.
Reasons For Disputing Car Insurance Claims
Disputing a car insurance claim is usually the last hope for someone who has been in an accident. These are the main reasons South Africans dispute their car insurance claims.
The most common reason someone might dispute their claim is if their insurer completely denies it. There are multiple reasons why an insurer might deny your insurance claim, including:
- Your premiums are not up to date.
- You were under the influence of alcohol or drugs at the time of the accident.
- Your car was not roadworthy at the time of the accident.
- Your car was used for commercial/business use at the time of the accident (most insurance policies are only for private use cars).
- Your car was not parked in a secure spot when stolen.
- You did not report the accident at a police station.
- A person without a valid South African license was driving the car.
Another reason someone might dispute their claim is if their insurer pays out an insufficient amount. Insurers pay out insufficient amounts, most commonly due to underinsured vehicles or policy limits. So, making sure you insure your vehicle for the right amount is important, and you should carefully read through the terms and conditions in your policy contract.
Remember, insurance companies do not pay out to fix the damage on your car if you only have third-party insurance. Comprehensive insurance is needed to provide funds to repair your car or pay out a lump sum equal to the market value of your vehicle.
Internal Disputing Channels
If you disagree with the results of a motor vehicle claim, you can go through the internal disputing channels of your insurance company. Most companies have clear instructions and specific procedures on how and when to dispute a claim.
You would probably need to submit a written dispute and have supporting documents to support your findings. That is why gathering as much evidence as possible at the accident scene is vital. You could also request that a senior claims assessor reviews your claim to get a second option.
Internal disputes need to be checked regularly, which will show the insurer that you’re not going away and expect a fair and reasonable payout from your claim. When you are involved in an internal dispute with the insurer, ensure the insurer knows that you will seek additional support if you cannot reach an agreement.
The Ombudsman
An ombudsman is an independent body responsible for resolving disputes between individuals and companies/organisations. They approach conflicts in an objective matter and seek to facilitate the dispute in a civil case.
In South Africa, some ombudsmen specialise in vehicle insurance claim disputes. Generally, the Ombudsman for short-term insurance (OSTI) is used in cases of vehicle insurance claim disputes. You can only dissolve a disagreement with an ombudsman if you have attempted to go through the appropriate disputing channels with the company.
Before contacting the ombudsman, you should ensure you have all the necessary documentation and evidence supporting your reason for disputing. You should also have evidence that you have attempted to go through the official disputing channels of the company.
Be prepared to explain the whole case again in detail, and also be prepared to write a written statement explaining everything that has happened in detail. Contacting an ombudsman should be your last resort when disputing a car insurance claim to get the payout you feel that you deserve.
Tips For Maximising Your Chances Of a Successful Car Insurance Dispute
It can be stressful and time-consuming to dispute your car insurance claim. Listed below are a few tips to improve your chances of resolving your issue:
- Know the ins and outs of your policy: Before even filing a claim with your insurer, read through the terms and conditions of your policy. Familiarise yourself with your coverage limits, deductibles and exclusions. This will also help you to know precisely what you are entitled to according to your policy contract.
- Document everything: Ensure you keep a detailed record of all communication with your insurer (emails, calls, or any other correspondence). This will make the process more manageable if you need to approach an ombudsman. This is vital and cannot be stressed enough.
- Don’t give up: The whole disputing process will be long and tedious, but don’t give up and accept an unreasonable payout to ‘have it done with’. Keep going and ensure you get the benefits stated in your policy contract.
Some attorneys will be able to assist you if you feel that the internal disputes and the ombudsman did not resolve your issue. Legal action is rarely needed, but it is also an option worth considering. Do not give up on getting the payout you deserve.
Final Thoughts
When disputing a car insurance claim, you should be fully aware of your rights to fair and reasonable compensation from your insurance company. There are several internal channels and external sources that you can turn to for help if you’re ever in this situation.
Make sure to document all communication with your insurer, study your policy contract carefully, and contact an ombudsman if you feel it necessary. With the proper support and perseverance, you should be able to get the payout you deserve from a car insurance claim.
