Posts Tagged ‘insurance claim’

Can I claim for pothole damage?

Written on April 8th, 2010 by admin
Categories: Car Insurance Advice, Car Insurance Claims, General Information

Many visitors to the Arrive Alive website and the Car Insurance Blog have searched for more information on how to claim for damage to tyres and vehicles as a result of potholes on our roads. These searches are for both the terms pothole and pot hole! Irrespective of whether the spelling should be pothole or pot hole – this is a source of great agitation for many a road user!

Can I claim for damage caused by potholes?

The easy answer is – Yes – You can. There is a responsibility on the side of the authority to maintain roads and repair potholes. It will however also be a matter for the Law of Evidence as well as a matter to establish blame. The question would be whether there was negligence on the part of the roads or municipal authority in not repairing that pothole – thereby removing a clear and present danger to the road user. There are reported cases in our law of significant damages awarded to people injured in accidents caused by these potholes.

Where do I claim for damages from potholes?

This is where this becomes a bit more technical and difficult. We need to ask the question – where did the damage occur?

The best safety net for road users is the one provided by the National Roads Agency – and this applies to the so called “N”roads such as the N1, N2, N3 …N12 etc.

SANRAL contracts with road works companies to maintain these roads, and they have to provide proof that they have an insurance policy in place to cover claims for liability from road users.

Claims for damages from potholes on National Roads are therefore directed to SANRAL and from there to the specific contractor on that stretch of road.

On the Municipal roads- where most of the damage will unfortunately be caused – the road users would have to approach that specific municipal authority or Department of Public Works and enquire from them which documentation to complete, and to whom to submit such a claim. This might unfortunately take more time and is also dependant on the efficiency of that municipal office!

What is needed when submitting a claim for pothole damage?

It is important to remember that there needs to be information available to evaluate the claim. I these times of insurance fraud it is important to prove that the damage was caused by a specific pothole, at a specific place and to a specific vehicle. It is also important to show that there are not 2 claims for the same damage – so you may not claim from both your insurer and the insurer from the road works company.

We have a copy of such a claims document received via fax from a road user who suffered damage as a result of a pothole. Even though this is from damage on the National Road – this will also provide insight to what would be required for other claims.

Information required would include:

Your ID Document
Your Drivers License
The Registration Details of your Vehicle
3 Written quotes for repair
A Declaration signed by the claimant

We would like to suggest that the vehicle owner also provide proof through photos of the pothole and the damage to the tyre and vehicle.

We have made the effort to provide the contents of the claims document for damage from potholes on our National Roads:

Page 1 Cover Letter

Without Prejudice
Date:
To:
Fax:
Tel:
Please complete and Return To:
The South African National Roads Agency (LTD):
For Attention
The Regional Manager
Northern Region
Private Bag X17
Lynnwoodridge
0040
OR FAX TO: Dimitri Alben
0866450784
Tel No: 012-426 6200
Email: albend@nra.co.za

Page 2 Information Required

Details Registered Owner of the Vehicle
Name & Surname
ID No:
Tel Home:
Tel Work:
Cell No:
Fax No:
Email:
Postal Address:
Physical Address:

Details of Driver at Time of the Incident / If different from the owner
Name & Surname:
ID No:
Tel Home:
Tel Work:
Cell No:
Fax No:
Email:
Postal Address:
Physical Address:

Vehicle Details
Model:
Type:
Registration Number:

Details of Incident
Date:
Time:
Speed Travelled:
Weather Condition:
Exact Location: National Road eg N1, N2, N3…..km..
Direction of Travel:

SAPS Information [Only of reported to the SAPS]
SAPS Docket No:
Police Station &Tel:
Date Reported:

Insurance Details
Company:
Contact details /Contact person:
Policy Number:

Please attach copies of (1) ID Document (2) Drivers License (3) Registration Certificate of Vehicle together with 3 written quotes for repairs.

DECLARATION:
I, ……hereby declare that this claim for alleged damage to my vehicle on the date and time described above has not been submitted to my insurers indicated or to any other insurers. If evidence to the contrary is revealed, I will accept that my claim will be declared null and void and that no further claim can be instituted against the South African National Roads Agency. I also declare that all the information supplied herein is true.
Signature Date

Page 3 Comprehensive Description of Incident

[This is a requisite to evaluate your claim]
……
……
[Please supply all requested information to expedite the process]

Also view:

Potholes and road damage drive demand for tyre insurance in South Africa

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Tags: Car Insurance Advice, insurance claim, potholes
Posted in Car Insurance Advice, Car Insurance Claims, General Information | 26 Comments »

Do older cars lead to more accident claims?

Written on February 22nd, 2010 by admin
Categories: Car Accidents, Car Insurance Claims, General Information

Would you expect more accident claims for newer or for older cars? It has been revealed by Virgin Money car insurance in the UK that cars that are three to six years old account for nearly 40% of insurance claims despite making up only 24% of all vehicles on the road.

What do the numbers reveal?

Drivers with five-year-old vehicles make the most claims (9.61%)
Owners of four-year-old vehicles make the next most claims (9.56%), followed by drivers of cars six years old (9.08%).

Virgin Money Car Insurance spokesman Grant Bather believes that this provides some justification to the trend by vehicle owners to change their cars every three to five years.

“This is not to say that cars five years old are the most dangerous, but that they are more likely to be involved in an incident that leads to a claim being made. This may be a traffic accident, breakdown or theft.
“Looking at these statistics, people looking at buying a second-hand car should also make sure that they have taken the necessary action to ensure that the car meets all of the road standards.”

Why does the vehicle age result in more car insurance claims?

It is nice to have this information –but meaningless if we do not discuss the possible reasons for the increased claims percentage!

We could consider the following factors as contributing to this data:

Vehicle owners are more alert and vigilant when driving a new car – they are perhaps more aware of the need to protect this asset.
Effective vehicle maintenance is usually in place for new vehicles.
Many new vehicles have a “car maintenance plan” for 5 years or 100,000 km’s – this result in effective maintenance and the roadworthiness of the vehicle.
Owners of older vehicles might be less attentive to the vehicle components required for safety on the road – such as tyres, shocks, brakes, lights etc
We also need to recognize that newer vehicles have more safety features such as ABS breaking, stability control etc.

The characteristics of the driver are also important. Few first time drivers will be able to afford a new vehicle – whereas older more experienced drivers will more likely drive newly purchased vehicles. Your younger less experienced drivers will more likely drive the older vehicle and this could lead to increased vehicle damage from accidents!

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Tags: car accident, General Information, insurance claim
Posted in Car Accidents, Car Insurance Claims, General Information | No Comments »

Car insurance claims may find smooth tyres slippery!

Written on October 12th, 2009 by admin
Categories: Car Insurance Advice, Car Insurance Claims, Ombudsman, Road Safety, Safe Driving Tips

The past weekend I have spent quite a bit of time researching run flat tyre technology and the impact that this might have on the safety of road users. Tyre manufacturers are spending much time and funding on efforts to develop tyres that are safer and that provides “run flat capabilities”.

All these efforts are however in vain if the driver does not monitor the condition of his tyres. We can have the best tyres from the most reputable tyre manufacturers, but if those tyres have travelled too far and are worn out, they simply would not be able to provide the necessary grip on the roads!

In the event of a car insurance claim, the insurer may reject the claim if the accident was the result of operating a non-roadworthy vehicle. We have previously written about this in a blog titled “Car insurance claim can be rejected if vehicle tyres are not roadworthy!”. It is however important to recognize that such dismissal/ rejection of a car insurance claim would not be accepted merely by having a look at the appearance of the tyres –but by asking whether there is a causal connection between the smoothness of the tyres and the accident.

We would like to refer to an actual example/ decision by the Ombudsman for Short Term Insurance.

Facts:

The Insured entered a traffic light controlled four-way intersection at a speed of 50 to 60 Km/h. The green light was in his favour and just before he entered the intersection, an Isuzu white Bakkie entering the intersection from the opposite direction executed a turn to the lsuzu’s right, i.e. across the direction of travel of the Insured. The Insured applied brakes slightly and noticed that the light was still green for him. To his surprise a Mazda 323 followed the manoeuvre of the Isuzu Bakkie and a collision occurred. The Insured’s Toyota collided with the Mazda’s left rear door. The Insurer rejected liability on the ground that the two front tyres were smooth and that liability is excluded as a result of “damage to the vehicle caused by or attributable to an unroadworthy condition of the vehicle”.

Ombudsman’s response

The Ombudsman pointed out that having regard to the circumstances of the collision, the smooth tyres had no causal connection to the collision and the subsequent damage to the complainant’s vehicle. The Insurer was persuaded to meet the claim.

From the above we can see that the mere presence of smooth tyres will not repudiate the accident claim – it must be one of the factors that caused the accident. The condition and smoothness of your tyres are important for car insurance – but even more so for your safety on road!

Also view:

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Tags: advice, claims, insurance claim, Ombudsman
Posted in Car Insurance Advice, Car Insurance Claims, Ombudsman, Road Safety, Safe Driving Tips | No Comments »

Car insurer must know the risk area where you are driving.

Written on September 30th, 2009 by admin
Categories: Car Insurance Advice, Car Insurance Claims, Ombudsman

Risky driving!

A car insurer has to take several factors into account when calculating the car insurance premium payable. These factors include driver factors, vehicle factors as well as the area where the owner intends to drive such vehicle most of the time. The car insurer will seek to determine how these factors will influence the risk to vehicle loss or vehicle damage.

Why do we say that the area is important? Insurers can use accident data and crime statistics to determine what the risks are to the specific vehicle to be insured. In the same way that property prices differ from area to area, the risks to vehicle damage or loss may differ. Accident data will reveal that many more accidents occur in the heavily vehicle populated cities than in towns and rural areas. Crime statistics will also confirm that the risks of hijacking, vehicle theft and smash-and –gab are much greater in our cities than in smaller towns! It is only reasonable to expect that the greater the risk of vehicle damage/ loss, the higher the insurance premium payable.

But why is this important for the insured client? Apart from determining the premium payable, the client will have to ensure that he abides by the stipulation in his policy contract to disclose any changes in the risk status. This means that in the event of a change in regular driver of the vehicle or risk area, the insurer has to be informed and a new premium calculated. Failure to do so will constitute a serious breach of contract and the insurer could reject his claim!

I would like to provide an example from a decision by the Ombudsman:

Facts:

The Insured owned five vehicles, all of which were insured and it was noted on the information given that the risk area was Durban, where the Insured resided. A Toyota Conquest was regularly used by the Insured’s daughter, and in April 2005 was taken with her when she moved to Johannesburg to attend university. The Insured did not advise the Insurer of the change in risk profile, and when a claim was lodged five months later, it was rejected. The Insured was adamant that there was no obligation on him to have advised the change in risk area as this requirement was never brought to his attention at any stage.

Ombudsman’s Response

The Ombudsman (subject to critical comment from the Insured), advised the Insured that the Insurer’s decision was correct and gave the relevant explanation in support of the rejection of the claim.

[Source: Ombudsman's Briefcase Issue No. 02/2006]

This Decision should raise alarm bells with many insured vehicle owners. This is a scenario that often plays out with our young drivers. Parents buy a vehicle for a child on the platteland or small town, insures the vehicle correctly in the name of the young driver and then allows the child to take the vehicle to the city where the child studies or works for 3 years or more.

Failure to disclose to and notify the insurer of such a change in the risk area is a breach of contract and will entitle the insurer to reject a claim by the insured client. We are not referring to short term changes such as business trips, vacation etc, but rather a prolonged change in risk area where the vehicle is to be driven.

We need to emphasize the importance of communication between the client and his insurer. Car insurance should not be seen as a once-off event – but rather as a continuous relationship between parties which needs adjustment and fine-tuning as circumstances change!!

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Tags: advice, Cheaper car insurance, choosing car insurance, crime statistics, insurance claim, Ombudsman
Posted in Car Insurance Advice, Car Insurance Claims, Ombudsman | No Comments »

Be alert to the types of Car Insurance Fraud

Written on September 22nd, 2009 by admin
Categories: Car Insurance Claims, Insurance Fraud

insurance fraud Many have asked the question – “Why are car insurance premiums so expensive?” This question has multiple answers including theft, road conditions, escalating costs of vehicle repairs etc. Unfortunately many insurers have to increase car insurance premiums due to the substantial rate of fraud in the car insurance industry. Industry experts have estimated that from 25% to 33% of all car insurance claims have elements of fraud to them.

But how innovative are these vehicle owners when making their fraudulent claims? How can we identify them? We can differentiate insurance fraud in hard fraud and soft fraud and provide a few examples from actual incidents.

Hard Fraud / Fabricated Car Insurance Claims

This is a carefully premeditated act with the purpose of benefitting from a false claim. The loss of property, in this case a motor vehicle is planned or spun out of thin air in the hope that the insurer will pay out the value of the policy.

There is a growing tendency for insurers to submit fraudulent claims where the entire loss is fictitious. Recent reports revealed that some vehicle owners in South Africa were taking their own cars across the borders of neighbouring countries, only to claim they were stolen so that they could claim insurance money. The objective is to benefit from both the sale of the vehicle across the border and the payment of the insurance claim!

Another simple example of a fabricated claim is where the owner of a vehicle parks his already damaged car in the path of a storm so branches and hail damage the car, and then files a claim to have the car repaired.

Soft Fraud / Exaggerated Car Insurance Claims

This is the white –lie equivalent of insurance fraud where claims are usually exaggerated following a loss. The insured does have a valid claim but instead of just claiming for their actual loss they increase the amount of the claim by either claiming for goods of a far superior value than the actual goods lost or stolen, or by claiming goods that were not lost or stolen at all. A vehicle might be stolen and the insured might claim that other expensive items were in the boot of the vehicle or that the vehicle had a very expensive sound system installed etc.

In this example the insured claims more from the insurance company than he is entitled to. This is the most common type of fraudulent insurance claim and the most difficult to prove. The risk to the vehicle owner is that if such vehicle is recovered and it is found that the claims to the expensive material are indeed false – the insurer might reject the entire claim!

A lesser known case of insurance fraud is where the insured provides false information to prevent the insurance company from taking a technical point or delaying payment of the claim. The insurer may gather false statements from fictitious witnesses of have a signature forged to have the claim paid.

Insurance fraud forces the insurers to appoint more claims investigators and to scrutinize claims very carefully. Unfortunately this increases the car insurance premiums payable by you and me…

We would like to urge all vehicle owners to be alert to these fraudsters and to blow the whistle on those who dare to benefit from fraud to the detriment of other innocent vehicle owners!

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Tags: insurance claim, Insurance Fraud
Posted in Car Insurance Claims, Insurance Fraud | 2 Comments »

Will car insurance cover damages if my unlicensed child causes an accident?

Written on September 4th, 2009 by admin
Categories: Car Insurance Advice, Ombudsman

YOUNG_DRIVER This is a scenario that several parents have experienced. A former colleague of mine was on a hunting trip when his son took the car and a few friends on a pleasure drive. They crashed the car and tragically one of the passengers died in the accident. This presents several legal questions – but for the purposes of this blog we would like to focus on the car insurance cover and financial consequences!

There is not a straightforward answer to this question – and it might be best to refer to a specific example which was dealt with by the Ombudsman for Short Term Insurance. This was appropriately titled “Parent’s nightmare”.

Facts:

On the morning of 21st April 2005, the Insured’s wife woke up at 6.00 a.m. and discovered that her son was not in his bed and that their car and the car keys were missing. The Insured was woken up and he then started making phone calls and eventually went to the nearest Police Station. Whilst there, he was informed that his son had taken the car during the night whilst his parents were sleeping and had a collision at 3.30 a.m. Because the son was afraid of his father, he did not wish his parents to be informed.

The Insurer rejected the claim based on an exclusion in the Policy that there is no cover should the vehicle be driven by an unlicensed driver.

Ombudsman’s response:

It was pointed out to the Insurer that as the use of the vehicle by the son was unauthorised and without any knowledge or consent of the parents, the exclusion would not apply. The Insurer conceded and settled the claim in the amount of R110 900,00.

[Source: Ombudsman Newsletter: 03/05]

It is important not to merely accept this example as the basis for argument that insurers will always pay for damages to such a vehicle. We need to focus on the “Unauthorised use” of the vehicle. The policyholder in this factual scenario could rely on facts such as the time of collision, the fact that the policyholder was not aware of the usage etc.

The insurer will not merely accept an allegation of unauthorized usage. The investigators appointed by the insurer will seek to find confirmation of the prior history of vehicle usage. If there is reason to believe that the parent was aware that his vehicle is used by the child and the child has previously been spotted driving the vehicle -the claim will be dismissed! This question can only be answered after all the facts in the specific scenario have been taken into account!

Rather leave vehicle repairs in the hands of the experts.

Written on August 31st, 2009 by admin
Categories: Car Insurance Advice, Car Insurance Claims, Car Repairs, Ombudsman

Back Yard Repairs

Have you also been told about some brilliant backyard mechanic who can repair your vehicle at a fraction of the costs? A frequent cause of unhappiness for the insured car owner is unsatisfactory repairs to the vehicle after an accident. This complaint is usually that repair work done is inefficient or defective or that the vehicle has not been restored to its pre-accident condition, or a combination of both.

The Ombudsman for Short Term Insurance has provided the following guidelines to insured car owners with reference to repairs on their vehicles!

Find out if your Insurer is paying you your loss or reinstating the vehicle.
If it is paying your loss (less excesses) you deal with the repairs and the repairer. Your loss is usually the fair and reasonable cost of repair.
If it is reinstating, the repairers are Insurers agents and should look to Insurers for payment; you are entitled to the repaired vehicle in as good a state as it was prior to the accident, and you are obliged to pay any excess to the Insurer.
Read your policy conditions to check whether there is anything which affects the basic positions set out above.
If you are satisfied that you can prove that what the Insured is offering you in money does not represent your proper loss less excess, or that the vehicle has not been properly restored, then object, and if you cannot achieve satisfaction, approach the Ombudsman if you want mediation, or your Attorney for advice as to whether you should assert your rights in a Court of Law.

We would like to advise that policy owners communicate clearly and without delay with the insurer. It is best to be fully aware of all the facts and to make an informed decision – only by doing so will you be able to avoid nasty and costly surprises!

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Tags: Car Repairs, claims, insurance claim, Ombudsman, repairs
Posted in Car Insurance Advice, Car Insurance Claims, Car Repairs, Ombudsman | 1 Comment »

When do I notify the insurer of an accident claim?

Written on July 28th, 2009 by admin
Categories: Car Insurance Claims, Ombudsman

The quick and easy answer would be – when does your policy document require you to provide such notification? It is important to remember that your insurance policy is the written agreement between you and your insurer. You pay a monthly insurance premium and the insurer agrees to provide compensation when a specific event occurs. The insurer will compensate for that damage after the accidental damage has occurred, and once you have complied with the complete and timely disclosures required in the policy!!
It is important to keep the policy documentation in mind in the event of an accident. Failure to follow the terms of the policy will amount to breach of contract and the insurer cannot then be held accountable for failure to provide compensation to the insured!
It is best to illustrate this with an actual example of a claim that was referred to the Ombud for Short Term Insurance:

Written notification of Car Insurance claim within 30 days

Facts:

The Insured’s motorbike was damaged in a collision on Thursday, 20th June 2002. The following day, i.e. on Friday, 21st June, he gave telephonic details of the collision to his Broker which telefaxed to him on Monday 24th June, claim forms. The motorbike was taken on a trailer to Linex Yamaha during that week, and he was only able to collect the quotation from Linex Yamaha the following Tuesday, i.e. 2nd July 2002. On Friday, 12th July 2002, his 79 year old father fell and was placed in Universitas Hospital, Centurion. The Insured being a single parent and between his responsibilities with his father, son and work, only managed to get to Linden Police Station on Tuesday, 23rd July 2002, to get them to stamp and sign off the motor accident claim form. On Thursday, 25th July 2002, he faxed the claim form together with the quotation to the Insurance Broker. The Insurer rejected liability because the claim was not reported in writing within thirty days of the event. The Insured was five days late within giving written advices to the Insurer of the claim.

Decision:

In view of the strict conditions of the Policy, requiring written notification of the claim within thirty days of the event, the Ombudsman could not make a ruling against the Insurer.
Source: Ombudsman Newsletter : 02/03

Advice:

We would like to advise all policyholders to keep their policy documents in a safe place – follow the steps taken as stipulated in this document and do not be the cause of unnecessary delays! Contact your insurer and always remember – there is nothing quite like enquiring!!

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Tags: claims, insurance claim, Ombudsman
Posted in Car Insurance Claims, Ombudsman | 1 Comment »

Posts Tagged ‘insurance claim’

Can I claim for damage caused by potholes?

Where do I claim for damages from potholes?

What is needed when submitting a claim for pothole damage?

Page 1 Cover Letter

Page 2 Information Required

Page 3 Comprehensive Description of Incident

What do the numbers reveal?

Why does the vehicle age result in more car insurance claims?

Written notification of Car Insurance claim within 30 days

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