Rejection of Claim.

Humble Hearts Academy and Aftercare (PTY) LTD 276 Tipperary Street Hennopspark 0157 *** ***

13 May 2024

Attention: *** TO: Whom it May Concern RE: Rejection of Claim Submitted; CIB\C591994/1

I would like to voice my disappointment in the handling of the above claim and the outcome. I am extremely unhappy with the manner in which the claim was handled, and I am most unhappy with the service provider (assessor) that was sent to our premises to review/assess this claim. Firstly I would like to state that I believe it is extremely unfair for CIB to expect clients taking out insurance in good faith to also be building experts. How is a “man in the street” or in my case, a retired police officer and my wife, owner of a children’s school/day care, expected to know and understand which building requirements are to be met. Should we not be guided by the Insurance Company, in this case, yourselves CIB. I would like to at this point draw your attention to a line item stated on your quotation, that I signed to take on this insurance:

The quotation states that it is subject to a satisfaction survey. At no point was this survey carried out. Would this survey, presumably to be carried out by someone with knowledge of building regulations, not have highlighted the fact that the wall was not up to building standards. Would this survey not have highlighted the risk with the wall, at which point you probably would not have covered the wall. But instead, no survey was done, and CIB has been happy to accept my premium for nearly 2 years. Almost 2 years that I have paid a premium, believing that my risks are covered and the first time I claim, I am told my wall is not up to building standards/regulations. I cannot understand how a company can happily take a premium for almost 2 years, but never did the initial survey to ensure that the building met the minimum requirements. In my mind, if no survey was conducted, then CIB should accept the premises as is and be liable thereof. This is my first issue with the rejection of my claim. My second issue with the process, and also very concerning, was that of the actions and behaviour of your service provider/assessor. It honestly feels after the fact that this assessor visited here under false pretences. During and following his visit he gave the impression that everything was in order and that he would be assisting to have the matter resolved and the repairs carried out. During his assessment he gave no indication of any problems, rather informed me of how it will all be resolved and what building repairs would take place. In my mind, after the assessor left, I was waiting for notification of when the repairs would commence and not that my claim would be rejected. During his inspection he pointed out area’s that would be repaired, he even went so far as to tell me that the wall that had collapsed would be replastered so that the branding which was on this wall could be replaced. The assessor also informed me that he would add an additional 4m to the repair quotation to make sure any unforeseen items are taken care of. The assessor also mentioned that he would handle the cutting of tree roots to avoid future occurrences. I believe it is in extremely bad taste that a service provider/assessor of your company creates false expectations and has your client believing that all is okay and that the repairs will be carried out.

Further to the above, I received the below from my broker, during the claims process:

I would like the assessor to explain some of the above comments, as again, the above screenshot of the email, does not match the physical conversation the assessor had with me, in person. During his assessment the assessor spoke of how the repairs would be carried out, not of anything to do with wear and tear. Also, his comment that according to clients, wall was leaning for a while before it fell – Is false, at no point did I say this to the assessor. As an ex-Police Officer, I am prepared to take a lie detector test, I wonder if the assessor would subject himself to the same. I have also been sent photographs that the assessor apparently took when onsite. I question the photo with the tree. This tree is not near any boundary wall, so I again question which tree roots would cause a wear and tear problem? I also query the comment of the assessor that the remaining wall is leaning over. If the assessor is referring to the photo’s below, two of which are of the wall that collapsed, the other is of a section not adjoining the collapsed wall, so I would like him to clarify which wall is leaning and has cracks. Again, if there was an initial survey conducted, we probably would not be in this situation.

In closing, I wish to summarise my disappointment and dissatisfaction with both CIB Insurance and the Assessor appointed by CIB. No initial survey conducted, yet happy to take my premiums. Consumers of insurance and not building experts, we are also not insurance experts. We rely on insurance companies to provide us cover for our risks, if the risk is not insurable, then we should be told this upfront and you should not take our premiums. That money could have been used to repair a wall not insurable. If you do not conduct the survey, then in my mind you should accept the risk as is the present condition. When we purchased the property, we had to accept as is, we are not building experts to know that a boundary wall does not meet your specifications. I feel your service provider/assessor should be taken to task for misrepresentation. If he is at our premises to find a reason to reject a claim, then he should state that and not inform us what repairs will take place and how we will be looked after. This is false. How can he look us in the eye and tell us how everything will be fixed, but in his report to you, tell you that this is not a claim. It is misrepresentation and has left a very sour taste in our mouths. Our hope is that you will review this case and find merit in the fact that there was no initial survey that took place. Therefore, premiums have been taken to cover a risk, a risk which has now occurred and needs to be repaired. It is our hope that your review of this case, may now result in a positive result in terms of the claim, and a payout so that we can have this wall repaired. To date, all of our premiums have been paid in full and we are a client in good standing. It is also our hope that your assessor / service provider will be taken to task for misrepresentation and that this kind of behaviour will not be tolerated in the future. One cannot create an impression of work will commence and then the next communication is that your claim is rejected, it is unfair and not ethical practice.

Please feel free to contact us should you require additional information, or any clarification with regards our complaint and request for acceptance of this claim.

Regards. Humble Hearts Academy and Aftercare.