Knowing what options are available to you when your claim has been declined or when you are dissatisfied with the settlement of a claim is vitally important.

These are the steps that are available to you:

This entails you personally gathering all your facts, drafting and sending an objection email concerning the matter directly to your insurance company.

This requires you to state the reasons for your objection, and mildly put, you first need to ensure that you have a clear understanding on the basis of the rejection, which includes the facts of the claim to which the decision was made upon. An experienced broker or financial advisor can also assist you in this regard.

Alternatively, if you are comfortable with the facts, then you can make your own case.  We do, however, suggest that you invest time and effort in constructing the objection, since a well-constructed and debated letter could lead to your insurer reconsidering their initial decision.

Remember, insurance companies make decisions based on the facts available to them at the time of the decision, so bringing in new facts and/or perspectives to the table may just get your insurer to see the claim in a different light.

Another aspect to keep in mind is that there are also other aspects that need be dealt with when claims are declined. For example, if the vehicle was declared uneconomical to be repaired, you would need to make arrangements to move the vehicle to a place of free storage. What to do with the salvage, especially when the vehicle is financed?  So there may be various aspects that need consideration once your claim has been declined.

The aforementioned objection needs to be made in writing to your insurer within 90 days from the decision being communicated to you.  Your insurer, according to Policyholder Protection Rules (PPR), has 45 days to respond to your objection. Most insurance companies respond timeously to objections, but this can become a time-consuming exercise with back-and-forth communication.

The second option available to you is to lodge a complaint with the Ombudsman for Short-term Insurance (OSTI). OSTI will not charge you a cent for their services, and it is absolutely free to lodge a complaint with their office. You can lodge your complaint here.  It is, however, always recommended to lodge a complaint to your insurer first.

If you do approach OSTI before lodging a formal objection, they will first transfer such a complaint to the insurer, giving them the opportunity to resolve it.  This is based on the complaints handling process that came into effect on 1 January 2019, where an insurer is now given an opportunity to resolve a complaint directly with the insured, whereas previously, the insured could freely lodge a complaint with OSTI before approaching his insurer.

OSTI returned just below R120m in value resolved in favour of the insured in 2020. So this is definitely an option that is cost-effective, not to mention that OSTI have the mandate to resolve matters through enforcement. This simply means that if they disagree with the insurers’ decision, they can resolve the matter by enforcing settlement to the insured.

Should your objection have been unsuccessful, as well as your complaint to the Ombudsman, you still have the opportunity to litigate the matter.  It is important to note that you need to institute legal action within 6 months after the expiry of your 90 days.

Appointing legal council is sometimes the only alternative to object to the outcome of your claim. But there is a favourite saying that goes, “the only people that get rich from principle ~ are lawyers.”  So be sure that you appoint an attorney that is well-versed in short-term insurance contracts.

Depending on the merits of the case, it might sometimes be wiser to cut your losses.  Remember that a contract is a contract, and no matter how you feel about the outcome, the decision might be based on solid legal grounds.

Court proceedings can take years to resolve, all the while incurring legal fees.  So, be sure to make an informed decision, which includes comparing the costs versus the merits of the case. I would be erring if I did not say that in court, a decision can go either way, depending on a number of factors.

What brings me to consider Prosumer Connect?

Prosumer Connect offer Dispute Resolution Services, which offers the insured individual consultation services in respect of their case. But why should you consider a consultation with Prosumer when you can do it yourself, or get free assistance from OSTI? The answer is simple… time is money.

Considering that your insurance company has a maximum of 45 days to respond to your objection, you could have already lost valuable time. If you, thereafter, contacted the OSTI, you would need to take into considering the average number of days it takes for them to finalise a complaint – this being 136 days, as per their 2020 report. This already totals 181 days – roughly equalling six months. Without needing to state the obvious, this is valuable time lost for the insured consumer who desperately needs their case finalised.

How can Prosumer Connect assist me?

Every case we receive will be personally reviewed by our Director and Founder, who has in excess of 25 years of experience in the short-term insurance industry – most of which was within the Claims and Investigations departments. He has not only headed up investigations departments, but is also qualified as a Certified Fraud Examiner.

The strength of an argument can support your objection and/or Ombudsman’s case, and oftentimes, the strength of the argument lies in the questions you pose.

A well-constructed argument can, therefore, save you a lot of time, energy and money in the long run. If the incorrect decision was made to a claim, we are confident that we can add value to your objection.

What Can I Expect from Prosumer Connect?

• Complete the form supplying the requested information
• We will review the merits of the case and advise if we can add value to it
• You will only be charged a consultation fee upon reviewing your case, and confirming that we believe we can add some value to you
• If we cannot see how we can add value, we will – at the very least – give you our independent view on the matter. This will be our independent opinion on the matter, based on the merits of the case and our many years of experience within the industry
• The above will all take place within 48 hours of receiving your form. Should we be able to offer value, and you accept, we will set up a telephonic consultation wherein we will discuss, in detail, the merits of the case and make recommendations to you.
• By the time of this telephonic conversation, Prosumer Connect would have studied all the supporting documentation to ensure a productive session can be held.
• Following the consultation and guidance, and upon your request to remain involved, we supply a quote to supporting you throughout the case.

What Does It Cost?

This initial consultation fee is only R500, all-inclusive per 30-minute consultation.

We review your cover, explore all supporting evidence, and ask additional questions to understand the merits of your case. The intent of this is to highlight pertinent points that you can raise and debate to strengthen your objection.

We also have many partners that could be of further assistance to your individual case, and therefore can give recommendations to a wide range of services.

Note:

Our values are that of transparency and fairness across the industry.  We, therefore, offer an unbiased opinion to the insurer and insured alike.  The solution we make available to our community is not one of finding loopholes in the insurance companies rejection, thus achieving a settlement, but rather to provide a service where we supply honest clients an independent opinion as to the outcome of their claim, in a completely unbiased yet highly-experienced manner.