CLAIM NOT PAID - NOT AN INFORMED DECISION

<p>AVINA RAMALINGAM, *** / ***</p> <p>CLAIM No : ***</p> <p>We experienced heavy storms over the Mother's Day weekend in May, in Durban. I logged a claim with Auto and General on 13/05/16 for water damage to the ceiling in my lounge. Today I was informed my claim will not be paid.</p> <p>I DO NOT agree with this decision. Here are the reasons:-</p> <p>1. I was informed of the claim rejection by claims consultant Verna, although I was told on the day of logging my claim that Azeezah Vallie is the claims consultant assigned to my claim. Apparently, discussing not paying my claim with me was of no importance to Azeezah.</p> <p>2. Discrepancies on the Assessors Report:-</p> <p>(a) When the assessor Naas came to my home, he walked into the lounge, looked at the ceiling for a few minutes. Here my husband informed him how we came to notice the damage. My husband showed him the repairs he himself had done to the ceiling which became damaged due to the too heavy light fixture. Naas complimented my husband on a very good job done. Naas looked at the ceiling for a few minutes, agreed it was water damage and then he took measurements. Please note, besides his measurement tools he did not have any other equipment with him ie ladder. He told my husband he wants to see the roof. My husband offered our ladder, he even pointed to where the ladder was, Naas said not to worry. He informed my husband he will look at it from the top ie the entrance to our driveway. Which he did, he also took a picture. The problem is the lounge is on the other side of the property, not facing the driveway at all. It is impossible to see the roof on the lounge side of the property from the driveway. There is no way that he would be able to photograph the roof there. My husband took a picture today in the very same place Naas stood. It shows very clearly the roof of my kitchen and bathroom. The roof on the other side of the house where the damaged ceiling is, is NOT visible in the picture. So how was the damage to the roof and ceiling assessed when he did not look at it?</p> <p>(b) The assessors report states there are 3 bedrooms, when in fact there are 2 bedrooms. He entered through my kitchen door which leads straight into the lounge. He went nowhere else, how would he know the number of bedrooms I have?</p> <p>(c) Comments on the report involving my husband’s comment regarding previous insurer and claim.</p> <p>(i) Our previous insurer is Hollard not Standard Bank as his report claims.</p> <p> (ii) In 2013, when insured with Standard Bank at the time, we did log a claim for the lounge ceiling because it was sagging. At that time we did not know what was causing the sag, so we contacted our insurer assuming it was an insured peril. When their assessor came out, he said the ceiling was sagging because of the weight of the lighting fixture, because of this it was not an insured peril. We accepted their decision and my husband repaired the ceiling himself. The same repairs Naas complimented him on. We now have a very non-fancy light there. There was not a water damage claim submitted then at all. There was no water damage to claim for.</p> <p>(d) Assessor's report implies that we are claiming for ulterior motives which is simply not true. We suffered water damage to our ceiling due to the heavy rains, which Naas agreed, and that is what we claimed for, nothing more nothing less. It is an insured peril, which we are insured for, all we did was use the facility available to us, that we pay for. We are law abiding citizens, we do not lie, cheat, ***** or commit crimes. I resent the implication that we would lie so that a claim can be paid. I am sure the value of the claim would be less than R3000. If it was not an insured peril, I would have the repairs done myself BUT it is an insured peril.</p> <p>(e) Sum insured on the assessors report - that information is private, what purpose does it serve the assessor to know that information? If he came to assess damages at my property, why does he need to know my sum insured? Does it allow him to do a more efficient assessment? Why did my insurer give my private information to a third party? </p> <p>(f) Assessor’s sum insured – how did the assessor come to that amount? At no time during his very *********** assessment did he look at anything else.</p> <p>3. Ruanne at the Assessor's office - I explained to her that I am alone at home and I politely requested that I need to know the time the assessor will be coming as I have to arrange for my husband to be at home. This was for my safety and also so that my husband can schedule it in his diary and inform his employer accordingly. She was unbelievably rude and aggressive, she refused point blank to accommodate my request. She even went to the extent of cutting the call on me. I called Auto and General, and informed Vaugh of this.</p> <p>4. Assessor behaviour - beside spending a few minutes on the assessment, he spent ALOT of time discussing my husband's cars and projects. Is this how Auto and General Assessors conduct themselves?</p> <p>After all this, the opinion I come to is that Auto and General made a decision based on a service provider who did not conduct a thorough and professional assessment. He did not have any equipment ie ladder, he did not even go onto the roof. All he did was take a picture from the kitchen side of the house. This will not show the roof where the damaged ceiling is. He spent more time discussing cars and not enough on the assessment.</p> <p>I WANT MY CLAIM TO BE SETTLED. It is not my business if Auto and General decide to conduct business with service providers who do not know how to conduct a proper and thorough assessment, to even assess the damaged area correctly. They decided to go into business with people who are inefficient and immoral in their field. That's for them to deal with. Their poor business decision should in no way impact me or my claim. </p> <p>I will say it again, there is no legitimate reason for my claim to be rejected. There is too many discrepancies in the assessors report. I also RESENT his implication that we lodged a ********** claim. I resent the implication that we would lie so that a claim can be paid. If it was not an insured peril, I would have no problem financing the repairs myself.</p> <p> </p> <p>BUT IT IS AN INSURED PERIL. Now Auto and General need to acknowledge their responsibility and fulfill their part of this contract and pay this claim. </p> <p> </p>