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Thread: Iffy claim repudiation

  1. #1

    Iffy claim repudiation

    With Insurance, there is the LETTER of the contract, and the INTENTION of the contract.

    For those who did not see it in the press, a guy totalled his R608,000 Audi, insured with Outsurance.

    When assessor gets there, there is (small) pre-existing damage. He had (a) hit a pothole, damaging his rim, and (b) had a conflicting accident with another vehicle. In both cases he did not claim as the damage was not high enough.

    Insurers declined the total claim, as he has has losses which "could have been claims", and should have been declared as it reflects his loss profile.

    Courts have upheld the declinature, saying it was material to the underwriting.

    Based on this, if you have a scratch on your car from a supermarket trolley, or a windscreen chip, you need to notify your insurers even if you are not going to claim.

    While the letter of the policy concurs, I have had numerous clients with non-direct insurers who have been paid out without a blink.

    The Direct guys, however, stick to the letter of what the policy says.

    Where is it better to insure? You tell me.
    PHIL COOPER
    Phil Cooper Insurance Brokers (Pty) Limited
    198 Jutlander Road, Beaulieu, Midrand.
    PO Box 31114. Kyalami, 1684.
    (P) 011-702-1328 (F) 011-702-1360 (C) 082-903-4754
    www.philcooper.co.za
    Authorised Financial Services Provider - Licence No. 17239

  2. #2
    Senior Member Subscriber Sharon's Avatar
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    Bastards I say! They look for any technicality to avoid paying!!

    I got burnt by Dial Direct before I joined this forum and 'met' Phil.


    Is this written into all policies Phil? Seems to be one instance where the consumer 'ignorance' isn't protected as in so many others.

    What was the courts reason - perhaps because of the no claim bonuses they pay out ie the guy was actually committing fraud in that he hadn't claimed so as to get his refund?
    Sharon

    Courage is not about having the strength to go on.. it's about going on when you DON'T have the strength!

  3. #3
    Hi

    It is a common clause in EVERY Insurer's wording.

    Outsurance told the Court that it affected the way they would have rated/accepted the account - it would have influenced their underwriting decision.
    PHIL COOPER
    Phil Cooper Insurance Brokers (Pty) Limited
    198 Jutlander Road, Beaulieu, Midrand.
    PO Box 31114. Kyalami, 1684.
    (P) 011-702-1328 (F) 011-702-1360 (C) 082-903-4754
    www.philcooper.co.za
    Authorised Financial Services Provider - Licence No. 17239

  4. #4
    So they really bent backwards on this one to repudiate the claim.
    Victor

    Knowledge is a blessing or a curse, your current circumstances make you decide!
    LED lighting solutions - www.simplelights.co.za
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  5. #5
    I know why I stay away from direct insurers.
    Houses4Rent
    "We treat your investment as we treat our own"

    marc@houses4rent.co.za
    083-3115551

    - Residential Serial Property Investor
    - Specialized Letting Agent & Property Manager (www.houses4rent.co.za)

  6. #6
    Read the full report of the claim today.

    - The second "minor accident" was nearly R200,000 - and according to witnesses the owner/driver has come from a pub, and was racing up and down a road, when he lost control and hit a parked vehicle.

    - It is STRONGLY indicative that the driver was over the top alcohol-wise when he had the main accident.

    I apologise in this case to OutSurance - this was a clear case of a wrongful claim, and I doubt if ANY insurer would have met it given the facts. 3 - Discovery, Santam and Hollard have categorically said they would not have paid it.
    PHIL COOPER
    Phil Cooper Insurance Brokers (Pty) Limited
    198 Jutlander Road, Beaulieu, Midrand.
    PO Box 31114. Kyalami, 1684.
    (P) 011-702-1328 (F) 011-702-1360 (C) 082-903-4754
    www.philcooper.co.za
    Authorised Financial Services Provider - Licence No. 17239

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