JOHANNESBURG’S HAILSTORMS AND FLOODING: WHAT YOU SHOULD KNOW BEFORE CLAIMING FROM YOUR INSURER

Johannesburg has recently experienced severe weather conditions which have impacted homes, vehicles, and businesses across the city. During events like these, most people turn immediately to their insurance policies, hoping their cover will provide them with much needed relief. 

However, before rushing into the claims process, it’s essential to understand what you are covered for, how to protect your rights as an insured person, and what to do if your claim is unfairly rejected. 

Understanding your cover 

The starting point in any insurance claim is your policy document. Many insured persons assume that rain or hail damage is automatically covered, only to later find gaps in their cover. Take the time to review your insurance policy and confirm whether hail, rain, storm, or flood damage is indeed covered. As well as what exclusions are applicable to your policy.

Should you be unsure, your insurer or broker must assist you in confirming your specific cover. 

Steps to follow when submitting a claim

If your policy does cover rain or hail damage, you should follow these steps to ensure a smooth claim process: 

• Report the claim as soon as possible: Most policies require a claim to be reported within a specified period. A delay can prejudice your claim; 

• Gather evidence: Take clear photos or videos of the damage. This assists both you and the insurer in assessing the claim; 

• Avoid repairing the damage yourself: Unless your insurer has given you express permission, do not attempt any repairs yourself. This may compromise the assessment process; and 

• Co-operate with the assessor:  Provide accurate and truthful information when an assessor inspects the damages. Misrepresentation can lead to repudiation. 

Repudiated claims and why do they happen

A repudiated claim is a claim that has been rejected by the insurer. This can understandably cause frustration, especially when you believe the damage should be covered. 

Common reasons an insurer may repudiate a claim can include the following: 

• The cost of repairs are less than your excess; 

• The damage occurred before you took out the insurance; 

• The event is not covered by your policy; 

• You misrepresented information when applying during the claim; 

• Your policy was cancelled before the event occurred; and 

• Your policy premiums were not paid up to date.

In the case of unpaid premiums, an insurer can insist that arrears premiums be settled before a claim can be considered. 

What to do if your claim is wrongfully rejected

If you feel that your claim is wrongfully rejected, you can take the following steps: 

• Request written reasons from your insurer: Ask your insurer to explain the specific clause or basis for their repudiation; 

• Provide further documents or clarity: If you are able to supply additional evidence, your insurer may be able to revise their decision; 

• Lodge a formal complaint: Every insurer has a dedicated complaints department, usually with a published complaints email address. Detail why your claim should not have been rejected and provide all the relevant information. The complaints are then dealt with internally by the insurance provider;

• Escalate to the Ombudsman or pursue further legal action: If you have tried to resolve your matter with your insurer by following their internal grievance procedure, but you are still unsatisfied you are entitled to contact the Ombudsman, who will typically require of you to submit a written complaint which sets out all the relevant details of your complaint, which will also include proof of your formal complaint with your insurer.

The Ombudsman have to come to a decision that is fair, by making decisions that are based on all information made available to them and having pre-set criteria for reaching a decision. You may also pursue legal action in the form of litigation against your insurance provider should you choose to not escalate a complaint to the Ombudsman.

Additionally, you can decide to engage in Mediation proceedings with your provider. Mediation is an alternative dispute resolution mechanism which involves a third party (Mediator) attempting to facilitate a settlement between you and your insurance provider outside of Court.

Conclusion 

Natural disasters place immense stress on both citizens and insurers. Understanding your policy, acting promptly, and knowing your rights can make the claims process far smoother. If a claim is unfairly rejected, you are not without remedies.  

Should you need assistance in interpreting your insurance policy or navigating a repudiated claim, feel free to contact us at Gittins Attorneys for assistance.