The Insurance Ombudsman has made it clear that if insured vehicle owners drive drunk – they are taking a very big safety as well as financial risk! We would like to quote as follows:
“Insureds must remain mindful of complying with their insurance policy conditions regarding the operation of a vehicle whilst under the influence of alcohol, to avoid the risk of having a claim rejected by their insurer or the risk of causing harm to other parties.
Some insurers have introduced options in their policies that provide insureds with the benefit of alternative transportation after they have consumed alcohol or are over the legal limit. Insureds are encouraged to educate themselves on their policy options and make use of the benefits available to them in order to avoid the possibility of a rejected claim on the grounds of driving under the influence of alcohol.
Insureds are reminded that insurance claims are civil matters and not criminal matters. In a criminal case the state is required to prove beyond a reasonable doubt that a driver was driving under the influence of alcohol. The onus in civil matters is different as the insurer is only required to prove on a balance of probabilities that a driver was driving whilst under the influence of alcohol.
What this means for an insured is that an insurer does not require blood or Breathalyzer tests to support a rejection of a claim on the grounds of driving under the influence of alcohol.
An insurer may rely on, for example, independent witness statements describing the driver’s demeanour, the amount of alcohol consumed by the driver prior to the incident, the manner in which the vehicle was driven and the manner in which the accident took place, to support the insurer in discharging its onus.
Some insurers elect to reject a claim on the grounds of driving under the influence of alcohol coupled with a secondary rejection reason for example:
- where the insured provides dishonest information to the insurer;
- where the driver leaves the scene of an accident unlawfully after an accident;
- an insured’s failure to exercise due care and or speeding;
- an insured’s failure to comply with the insurer’s reasonable request/s for beacon and billings or other information.
The above list is not exhaustive but is an indication of the most common issues that are usually related to claims rejected for driving under the influence of alcohol.
Where an insurer suspects that the driver was under the influence of alcohol at the time of the incident, an investigation is likely to take place to verify the incident driver’s
activities before, during and after the accident. Insureds must be aware that should they try to conceal facts or circumstances surrounding the incident by providing incorrect information or withholding relevant information from the insurer, this in itself may provide the insurer with additional grounds upon which to deny liability on a claim.
This is because most policies exclude cover for claims where the insured materially misrepresented the circumstances surrounding the loss.
In a dispute dealt with at this office, the insurer interviewed several witnesses who were present at the accident scene and who confirmed that the driver had been highly intoxicated.
Further, the insured’s tracker report indicated that the vehicle had been travelling at a speed of 124km/h in a 100km/h zone and had been travelling at speeds of 174km/h mere minutes before the accident. The insurer rejected the claim on the grounds of driving under the influence of alcohol and failure to exercise due care. OSTI upheld both rejection reasons.
Examples of such information often requested by an insurer are the beacons and billings for all cell phones registered to the insured, the insured’s bank statements for the incident date or contact details of any person who could verify the insured’s version of the circumstances surrounding the accident.
A common argument from the insured’s in this regard is that the requested information is irrelevant to the actual loss or that the information is private and sensitive and thus cannot be provided to the insurer. An insured should be mindful of their duties in terms of their policy requirements which often state that an insured is to comply with the insurer’s reasonable request for information.
An insured has to prove that their claim is valid in terms of the policy. The insured has a contractual duty to provide the insurer with all the necessary information and documentation to enable the insurer to validate the claim.
Insurers have structures in place to facilitate the investigation of a claim and to verify the information provided by an insured before accepting liability for the loss. A common misconception of insureds is that if all premiums are paid timeously, then an insurer is bound to accept a claim and provide the cover it undertook to provide. We reiterate, that a policy is a contract and the payment of premiums is not the only duty placed on an insured.
Insureds must also comply with the provisions of cover and bring their claims within the ambit of the policy. Where an insurer has proven on a balance of probabilities that the claim falls within the policy exclusions relating to driving under the influence of alcohol or that there was noncompliance with the provisions of cover, OSTI may uphold the insurer’s decision to decline liability on a claim.
Therefore OSTI’s advice is – do not be a statistic and do not drink and drive!”
How Much Is Too Much To Drink Before I Drive? The Safest Driving Rule is ZERO Alcohol! https://t.co/HxX00XpXo9 #ArriveAlive @DriveDry @AwareOrg @SADD_SA pic.twitter.com/t18VcAOdOf
— Arrive Alive (@_ArriveAlive) February 20, 2020