Claiming from Insurance? Don’t Wait Too Long…

 

If you need to file an insurance claim, don't dawdle. If you fail to get your paperwork in on time, your claim could be rejected – and it only gets worse from there.

 

There are various reasons why insurance claims are rejected. Sometimes it's due to missed premium payments, or contractual technicalities, or claimants taking fat, fraudulent chances. Sometimes, though, insurance claims are denied for the forehead-slappingly stupid reason that the insured person took too long to get their paperwork in.

 

Here's why you can't afford to faff around when it comes to your insurance: in South African law, there's a term called 'prescription', which is a lot like the 'statute of limitations' you often hear about on TV lawyer shows like Suits or Better Call Saul. It's basically an expiry date before which you have to file your claim.

 

When to report an incident

When it comes to car insurance, for example, you usually have 60 days (depending on the policy) from the date you become aware of the incident to submit your claim. Just remember, though, that in the case of a car accident, you'll also need to contact the police or report the accident at the nearest police station either within 24 hours if a person is injured or killed, or on the first working day after the accident if nobody was hurt. Don't waste time with this: you may need the case number from the police in order to file your claim. (This will depend on your insurer's requirements. Check your policy documents or contact your insurance provider directly to find out for certain.)

 

This applies to all kinds of insurance. Your policy will stipulate all of your obligations in the event of a claim, including the time period within which your claim must be reported to the police and the insurer, what information must be provided to the insurance company, what should (and should not) be done at the accident scene and even the period of time within which you can dispute the outcome of the claim.

 

Failure to comply with any of those obligations could result in your claim being rejected.

 

You would have noticed that even insurance claim disputes have a prescription period or expiry date. Usually, if you're not happy with your insurance company's decision regarding a claim, you would launch an appeal through the Ombudsman for Short-term Insurance (OSTI), who then mediates the dispute.

 

But again, you can't sit twiddling your thumbs. Most insurance policies have what's called a time-barring provision, which determines the date by which you are allowed to challenge the insurer's decision. If you take any longer than that, the OSTI can't help you.

 

The case of the late appeal

The OSTI has had a few instances like this over the years. On 14 November 2016, a client (the OSTI's case files call her Mrs S) lodged an insurance claim for lightning damage to her household items. Three days later she was told that her claim had been rejected because it didn't fall within the benefits provided by her policy. Mrs S escalated the issue, but on 16 August 2017 the insurer told her that after a long internal review, it was standing by its initial decision to reject her claim.

 

Two long years passed before, on 10 September 2019, Mrs S finally contacted the OSTI. She was too late: according to the terms and conditions of her policy (and according to the letter the insurance company sent her), she had six months to challenge the decision.

 

The OSTI asked Mrs S to provide reasons for the late submission of her complaint. She didn't respond, and the OSTI had no option but to uphold the rejection.

 

Moral of the story? Don't waste time. If you're filing an insurance claim, make sure you inform the police in good time (where necessary), make sure you get hold of your insurer before the deadline, and – in the rare event that you're not happy with the outcome of your claim – move quickly to resolve the issue.

 

If you're looking to change insurers – or if you want to see if you can get a better deal on your current cover – then use our free tools to compare car insurance quotes and household insurance quotes.

 

How to log an insurance claim the hippo way.

This article is for informational purposes only and should not be construed as financial, legal or medical advice.