A HIGH NUM­BER OF COM­PLAINTS AGAINST AN IN­SURER DOES NOT AL­WAYS MEAN THAT IT HAN­DLES CLAIMS UN­FAIRLY

CASE STUDY: You’ll be caught out even­tu­ally

Weekend Argus (Saturday Edition) - - FRONT PAGE -

A case study from the Short-term In­sur­ance Om­buds­man’s 2016 re­port il­lus­trates that if you bluff your in­surer, your ac­tions will even­tu­ally catch up with you.

Mr A claimed for the loss of his car fol­low­ing what he said was a hi­jack­ing. His in­surer, Mu­tual & Fed­eral, re­jected the claim, say­ing Mr A pro­vided false in­for­ma­tion at the time of the claim and had failed to dis­close im­por­tant facts about his in­sur­ance his­tory when he took out the pol­icy.

Mr A re­ported that he had driven to visit a col­league five min­utes away from his house in Khayelit­sha. On the way home, he gave an old man a lift to a nearby sub­urb, Harare. Af­ter drop­ping off the old man and be­fore he could drive off, he was ap­proached by two men, who beat him up and hi­jacked the ve­hi­cle.

Mr A said the per­pe­tra­tors had stran­gled him un­til he passed out. He later found him­self dazed, walk­ing to his cousin’s house.

On ar­riv­ing at his cousin, Mr A did not con­tact the po­lice or his wife. He said that his cell­phone had also been stolen. The next day, his cousin helped him re­port the in­ci­dent.

Mu­tual & Fed­eral’s as­ses­sor con­firmed dur­ing the in­ves­ti­ga­tion that Mr A did visit his col­league, but said Mr A gave a dif­fer­ent ver­sion of the story com­pared with his re­port on the claim form.

Mr A’s ve­hi­cle was later found burnt out and badly dam­aged.

It was dis­cov­ered that Mr A had sub­mit­ted an al­most iden­ti­cal claim two years ear­lier, which had been set­tled by a pre­vi­ous in­surer.

Mu­tual & Fed­eral ar­gued that Mr A had failed to in­form it when he took out the pol­icy that he had had poli­cies can­celled by two pre­vi­ous in­sur­ers. The in­surer also ar­gued that, in its view, Mr A had staged the hi­jack­ing.

The om­buds­man upheld the in­surer’s de­ci­sion to re­ject the claim on the grounds that Mr A had not dis­closed his in­sur­ance his­tory at the in­cep­tion of the pol­icy and af­ter tak­ing into con­sid­er­a­tion the dis­crep­an­cies in the cir­cum­stances sur­round­ing the in­ci­dent.

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