My insurer says the damage isn’t covered but I don’t agree!
22/08/2018 Insurance policies, like most contracts, can be quite frustrating to understand... Especially when all hell breaks loose and you find out for instance, that water damage is not covered by your insurance!
Whenever you take out an insurance policy, you may be tempted to overlook the long-winded details of what you are covered for and what is excluded under the insurance. However, the majority of denied or partly approved claims that are not a result of disclosure issues, are related to claiming for damage that you are not covered for .
Read your policy
If you have homeowners’ insurance for instance, and you are not absolutely certain of the different risks that are covered, now might be a good time to review your policy before you are left with a huge bill and a leaking roof or an empty house. It is important to understand that different policies cover different risks, and in some cases, certain risks require a special or specific policy.
If for some reason you didn’t receive a copy of your policy, you can contact your insurer via Resolver to request that it be sent to you.
Your insurer or your broker must provide you with information about your policy in the form of a summary - you must read it and make sure you understand it. The summary sets out in great detail what circumstance the benefits will be paid or not be paid, these are also called exclusions. This summary can be given to you in paper form or electronically, but you should receive it from your insurance company or broker within 60 days after you bought the policy.
Standard Bank correctly advises its customers with this small but very important note on their insurance page - “your premium may be lower if you don’t choose Comprehensive cover, but if you damage or write-off your car in an accident you will have to cover the costs yourself.” Similarly, the contents of your home are not automatically included in their Homeowners cover, you’d need to insure them separately!
Always understand why your claim was denied
Most insurers will always tell you why your claim was denied or why they could only pay for a portion of the damage. On the odd occasion that you don’t receive reasons as to why it was denied, you are entitled to ask for those in writing.
If you are told that the damage isn’t covered, ask your insurer to point you to the particular section in your summary that refers to the specific inclusions and exclusions.
My claim was unfairly denied!
If after reviewing your policy you feel your claim was unfairly denied or that the policy wasn’t clear enough, you should first take this up with the insurance company in question using Resolver. If you are still not happy with the outcome you can escalate your complaint to the Long-term Insurance Ombud or the Short-term Insurance Ombud via Resolver.
Before you take out an insurance policy, it is important to understand what you are seeking cover for. That way, your insurer is able to offer you a policy that includes all the risks you want to be covered for.