More and more claims are being rejected when they are submitted to insurers. l FILE
Johannesburg – The Ombudsman for Short-Term Insurance (OSTI) has recently noted the rise in rejected claims due to errors in the claim submission phase which is causing unnecessary rejections.
The mediation service is urging consumers to familiarise themselves with the terms and conditions of their policies.
“This is because it allows them to know what is covered and what to do when submitting a claim,” the OSTI explained.
“It also enables them to confirm if the cover provided meets their requirements.”
Assistant Ombudsman from the Ombudsman for Short-Term Insurance, Relebogile Mashego added that consumers should provide as much detail as possible when submitting a claim, such as the loss, its value, and the proof of ownership.
“Examples of documents that may be required or useful include quotations, damage reports, photos, videos, details of witnesses, statements, etc,” Mashego said.
The following listicle by the Ombudsman for Short-Term Insurance (OSTI) can be helpful.
– Contact your broker/insurer as soon as possible after the incident to notify them.
– Document or record as much evidence as possible -
– Report the incident to the police if applicable.
– Make sure your premiums are up to date.
– If emergency repairs are conducted, evidence must be preserved: Take pictures and videos, all required documents, and evidence for possible use in claim assessment.
– Ensure that you comply with the policy terms and conditions.
– Delays in notifying the insurer about the event.
– Failing or refusing to provide information, documents, or co-operate with the insurer during claim investigations or validation.
– Interfering with evidence, incident scene or the damaged property before the insurer does the assessment.
– Embellishing, exaggerating, or improving the facts to sound more compelling. It may amount to misrepresentation and compromise the claim.
– Do not fabricate facts, documents or evidence. This may amount to dishonesty or fraud, resulting in a claim rejection.
Meanwhile, Mashego added that it is not good practice for consumers to only review their policies after a loss or during a claim.
“Remember, insurance is meant to protect consumers against insured risks. Therefore, it requires a proactive approach, and it would help if consumers were familiar with their policies and observed their obligations.”
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