Prime South Africa rejected my car insurance claim – Hellopeter

Car insurance: Hellopeter complaints & bad service

How often does one see complaints about bad service and rejected claims on Hellopeter from frustrated or unhappy car insurance policyholders? Some people often complain of unfair treatment. They may even claim that theirs is the worst insurer in the country with such poor service.

Nevertheless, one should always remember that the intention of most insurance contracts is not to cover every loss under every circumstance. That would make premiums far too expensive and exclusive for most of us. Insurance products are often designed to target specific risks and exclude others.

What are common reasons for a rejected claim?

• The driver was unlicensed.
• The driver was not nominated or permitted to drive in terms of the policy. The vehicle was in an unroadworthy condition and this contributed to the loss – smooth tyres, faulty brakes, wipers, lights, etc.
• The driver was speeding, grossly negligent or under the influence of alcohol or drugs.
• Electronic data stored in the vehicle is at variance with accident details given by claimant.
• The policy doesn’t cover the type of loss incurred. For example, total loss policies provide cover only when the vehicle is a total write-off, is hijacked or stolen.
• Incomplete, inaccurate, inflated or fraudulent information is often provided at issue or claim stage.
• Upfront photos or pre-inspection of vehicle are not provided.
• The loss was caused by mechanical failure due to lack of maintenance i.e. insurer rejects claims on the basis that the insured vehicle was not serviced according to the manufacturer’s specifications and the vehicle’s condition contributed to the loss.
• Failure to comply with the insurer’s reasonable requests for information, including cellular phone records, etc.

Does the insurer have grounds for a rejected claim?

Early understanding of for claim rejections may help

In order to minimise complaints about claim rejections, the insurer clearly explains to a client when the Policy is issued the most common reasons (see above bullets) why a claim can be rejected. After such interaction, clients acknowledge that they have fully understood such disqualifying reasons. In this way, they may well be much less likely to go and complain – because they knew better in the first place. For instance, they can’t hide behind the excuse “I never knew that.” In addition, it is better for the client to be aware of all the disqualifying reasons before a claim rejection takes place, rather than discovering them at the time of rejection. When the removal of any misunderstandings is maximised through thorough information exchange, the chances of complaints occurring may well be minimised on Hellopeter. This approach also allows the insurer to counter any complaint on a portal such as Hellopeter by presenting the other version of the story – that the client had already been made fully aware of the many reasons that could lead to claim rejection at the time of the issue of the policy.

Rejection letter of insurance claim

When you have been advised by your car insurance company that your claim has been rejected, you will receive a letter of rejection from the insurer or its administrator formally rejecting the claim. This letter will clearly detail the grounds upon which the Insurer bases its rejection or repudiation. Read these grounds carefully in conjunction with the Policy document. If you do not have a copy of the Policy wording you are entitled to request one from your Insurer.

How do you deal with a rejected insurance claim?

Having examined the Policy document and the grounds for the rejected claim, you must make an initial decision on whether the facts set out as the grounds for your rejected claim are essentially correct. Do those facts, in terms of the Policy conditions, entitle your Insurer to reject or repudiate your claim?

If the answer to either or both of these questions is “No”, then you may well have valid grounds for complaint. It should, however, be remembered that where facts are in dispute it usually means that the issue can only be determined by evidence, and you may need to consider the strength of your evidence in support of your version of the facts.

Unfair treatment allegation – what must it be based on?

Before considering what step to take next, look at the matter unemotionally and put to yourself again the questions asked by the insurer. Remember, your perception of having received unfair treatment has to be based on fact, and not opinion.

Do not delay to make representations

Then do not delay in dealing with the matter. Most policies contain a clause which states that you may make representations to the insurer and request further information regarding the rejection. If you don’t institute action or lodge a complaint within a certain period of time after the rejection, you are usually precluded from doing so later.

How should you submit an insurance claim?

The bottom line is: be completely honest with your insurer when claiming, providing full information and evidence both positive and negative. This will allow them to reach a full understanding of the circumstances leading to your loss and will reduce the likelihood of receiving a rejected claim, unfair treatment or bad service.

Contact Prime’s customer care

Sources: