1 reviews | Active since Jun 2013
Insurance Claim rejected (and by dispute officer) dispite no evidence of lying or wrong doing
<p>PLease see my e-mail cprrespondence below:</p> <p> </p> <p> </p> <p>Good day</p> <p> </p> <p>Please find response attached.</p> <p> </p> <p> </p> <p>Kind regards, <br />Mohlago Makwela <br />Dispute Resolution Officer <br />t: ********** <br /> | <br />f: ********** <br /> | <br ********** /> <br /> </p> <p> </p> <p> </p> <p><br />MiWay Insurance Ltd. 48 Sterling Road, Samrand Business Park, Kosmosdal Ext 12, 0157, Gauteng.<br /> Reg No: ***. An Authorised Financial Services Provider (Licence No: 33970)<br /> Board of directors. View our email disclaimer, alternatively send a blank e-mail to ********** /> <br /> » Help the environment - please don't print this email unless you really need to!<br />From: David Oliver ********** com] <br /> Sent: Friday, November 25, 2016 2:37 PM<br /> To: Dispute ********** /> Subject: Claim: 793 884</p> <p> </p> <p>Hi </p> <p> <br />I would like to challenge the outcome of this claim findings as I believe that I was not fairly presented by claima assessor Buddy Vroom.<br /> <br /> <br /> <br />i would therefore like you to review the conversations both telephonic and in person soonest. <br /> <br />Here are my reasoning as to why I feel I was not given a fair assessment:<br /> <br /> My Claim denial basis<br />I was first told that I was being dishonest because a car cannot drive on 3 wheels. I was told its a fact that a car cannot drive on 3 wheel by Riaan and when I asked if I showed him a video of a car driving on 3 wheels, then could it be possible? He answered yes it could be. I asked him if it can conclusively be said that a car cannot drive on 3 wheel, he answered no. He then proceeded to say that they(MiWay) can get a reconstruction specialist and when I said yes please do. He then said no they will not do it. He said he closed the case and refuses to.<br /> <br /> Francois( Claims Manager) said that a claim can be reopened to be further investigated but he too wont do this and confirmed that MiWay can get a reconstruction specialist but wont, despite the fact that Riaan had initially offered me one. He said that if I want, I can go and get one myself and incur the costs.<br /> <br /> I explained to Francois that my car is a rear wheel drive and therefore the power came from the rear wheels to move the car forward. <br /> Please see link here to a car doing it: https://www.youtube.com/ watch?v=ZwLYd3Xxosc. In this video you can see that the car is also leaving no marks. This therefore disproves that I **** about this.<br /> <br />I also challenged Francois to stare the car and see if it can move forward. He then agreed that it could but said no they done want to because it would cause further damage. <br /> <br />I don't understand how they can deny my claim based on their opinions but when asked if it is possible they say yes. Are they then not contradicting themselves? and there for thereassesment must be reversed on this point.<br /> <br />They then brought up that I did not comply with a reasonable request but this is not that simple.<br /> <br />The assessor requested access to my private e-mail address and I said that I know why he needs it but I am not comfortable with sharing my personal email with him. As it is nededto access my email. He said ok but it may be seen as me not complying and therefore my claim being dismissed. He did not say my claim will be dismissed if i signed.<br /> <br />I specifically asked him if I sign this can I contest or give evidence that it is not relevant and said yes I will have such an opportunity. He assured me that it wont immediately make my claim invalid.<br />I was then later informed by Francois or Riaan that my claim was immediately denied when I signed that form. Firstly different from what i was told and I asked if this was true then why was my claim still investigated further by the assessor? After the assessor spoke to me I sent him a screenshot of the fact that my location was last updated on the 7th of November and my accident happened on the 19th.<br /> <br />I was also told that they could get my location otherwise but that would take too long for them to investigate. Why would that be a problem? <br /> <br /> <br />My claim was also denied because there are no marks in the road from my car. Which i dont feel is a fair assessment as there are many marks in the road, actually, and any of it can be mine.<br />Francois also agreed that it's fair to say any mark in the road can be mine.<br /> <br /> <br />Withheld evidence and lies told<br /> <br />I mentioned above that I sent buddy evidence that access to my location was irrelevant as my location was last updated 2 weeks before the accident. He told me on the phone that he will not present it in the case.<br /> <br />With regards to the scene he told me that there are no marks of where I said that the accident occurred (that he has photos of this) but when I said that there is as I drove pass, he then said yes there are some. <br /> <br /> It was said that I am an IT specialist. My documents or any information cant be trusted - This was a lie told about me by the assessor in the review meeting. Riaan let this slip while on the phone.<br /> <br />Before the review meeting. My assessor refused to accept my witness that my car had only 3 wheels when I arrived at home. But before me explaining what she was a witness to, he refused to accept her as a witness based on the fact that she is my girlfriend. How is this fair in an unbiased process? <br /> <br /> He too didn't ask for my brother as a witness to see if i was indeed on my way to him. I have whatsapp messages to say I was going to him and need to know where his keys are.<br /> <br /> <br />The relevance of this is evidence is that it corroborates my story. I don't understand how that when i offers facts in the case they get rejected but my claim can be denied on an assessors opinion(s).<br /> <br /> <br />I was not given a fair hearing and believe that my case was pre-decided. The assessor has absolutely zero facts in this case and all his outcomes are based on his personal thoughts.<br /> <br />When we first met, he told me about how he was also young and stupid once. He went on to show me the tattoo of a cross on his left arm and the tribal tattoo on his right. He went on and told me: "Come on, just say if you had a dop in. We all had a couple of doppe in before" and I paraphrase here. I don't understand how this was part of me giving my report. This was before he saw the car or the scene.<br /> <br /> He also continuously told me that if i lie I would be blacklisted by all insurance and that at any point we can cancel this meeting and he walks away and it will be as if nothing happened but I don't get paid out. I continuously responded with yes this is my story. Can I please continue it.<br /> <br /> <br /> <br />I would like a review of my outcomes before I take this case further. There is no evidence against me that my claim is not valid or that I **** at any point. If anything i was blatantly denied to present evidence that could prove otherwise. <br /> <br /> I would also like access to the calls between myself, Buddy( The assessor), Riaan (Team manager) and Francois (Claims manager) as well as my conversation with buddy in the car. Can these be reviewed as well please.<br /> <br /> <br />Regards,</p> <p>David</p> <p> </p> <p> </p> <p>That is the end of my correspondence via email, below is the response:</p> <p> </p> <p>We refer to your e-mail dated 25 November 2016, disputing the outcome of your claim. We have<br />reviewed the merits of this matter and herewith provide you with our response.<br />On 20 November 2016 you telephonically submitted a claim for damages sustained to your vehicle, a<br />2007 BMW 118i (E87), which were caused as a result of a single vehicle accident that was reported to<br />have occurred on 19 November 2016.<br />The claim was rejected on the basis that you provided MiWay with dishonest information, furthermore<br />that you failed to comply with MiWay’s reasonable request. The policy was cancelled, effective from 19<br />November 2016, being the alleged incident date.<br />During claims stage you provided that you were travelling from your brother’s residence to your<br />residence, at approximately 23h30. You furthermore provided that a person came out of nowhere into<br />the road and as you attempted to avoid the said person, you collided into the median on the side of the<br />road.<br />An assessor was appointed to validate the claim. You informed the assessor that after the alleged<br />accident, you left the accident scene as you did not feel safe. You informed the assessor that as you<br />were driving the right front wheel of your vehicle came off and you continued driving the incident vehicle,<br />without the wheel, for approximately two and a half kilometres until you arrived at your residence.<br />The assessor visited the accident scene and found that the scene did not match the incident description<br />you provided at claims stage. The assessor could not find any points of impact on the median, nor signs<br />that an accident had occurred in the area that you pointed out. The assessor also noted that there were<br />no drag marks that the chassis would have made, as it made contact with the road surface while you<br />were driving to your residence.<br />Furthermore, the assessor requested access to your Gmail account in order to validate your<br />whereabouts prior to the incident. You informed the assessor that you know how IT works and that you<br />know that the assessor wants to obtain information regarding your prior whereabouts. You informed the<br />2<br />assessor that the information we requested is personal and that you would not comply. The assessor<br />suggested that you grant him access in your presence to allow him to obtain the required information.<br />The assessor provided you with a reasonable request letter, which you signed “will not comply”.<br />Kindly be advised that by failing to provide MiWay with the requested information, you have<br />prejudiced MiWay’s validation of the claim and determination of whether the claim falls within the<br />ambit of your policy.<br />In light of the above it is clear that you provided MiWay with dishonest information regarding</p> <p> </p> <p> </p> <p>In conclusion once again:<br /><br />There are accdient marks and they said i **** because a car cant drive on three wheels because, then said it could after I discussed how with them and this is on of the basis for rejecting my claim<br /><br />I explainged numerous occasions that I never oncesaid I'm an IT specialist and they said they habvea recording of me stating this in our meeting, which i requested and still have not recieved.<br /><br />Yes i denied access to my location and i explained to the assessor that i understand why he needs it but it has all my personal information. He just asked me to sign a document stating that I denied him access to my e-mai l and said that it could be seen as bad but he never said that my claim is immediatley rejected. My evidence has been rejected, my witnesses denied becuase it's my girlfriend and overall bad treatment. I have been labelled a **** on the basis of no evidence from your team. Defamation of my character.<br /><br /></p> <p>As fpor the location thing, Riaan said that tey can get it via my service provider and I gladly agreed to it and hethen said no. This alternative was not offered to me as stated in my e-mail to disputes. If there is another way to get my location and i gladly agreed then what is the problem? I'm sorry but you cant expect me to give acces to my personal information while parked in a car and on his device. Then the only time I will be able to change my information is when i manage to get back to the office.</p> <p> </p> <p>And I am still waiting for when I saidf I'm an IT specialist!!!??? And the recording they said they had.</p> <p> </p> <p>I also requested all the recording between mysel and the memebers of MiWay and even gave time and dates to make it easier as the dispute officer requested. It still has not been sent, I'm going to need this </p> <p> </p> <p>I clearly have nothing to hide, i dont get why this process has been so difficult. It's been almosta month now. Come on man.</p> <p> </p> <p>Your dispute officer literally copied and pasted what was told to me before. Can you please check if she even downloaded or requested the call logs. I want proof of this as well. I am going to need it as evidence.</p> <p> </p> <p>Apologies for the length and any spelling and grammar mistakes.</p> <p> </p> <p>Regards again,</p> <p>David</p>
This is the rest of the email correspondence:
Hi Mo
As discussed please see date below of interaction below for recordings request:
Buddy Vroom (Assessor)
First call: 22/11 @ around 2pm
then:
23/11 multiple calls (+- 7 calls) from around 11 am - 2 pm
25/11 multiple calls from 7 am - 12 pm
The meeting happened on the 25th of November, unsure of time
Riaan (Team leader) on the 25th: he called me on ********** ( I think this is the number) @ 12:17 pm
Francois Smit: Claims manager: called him at around 1 pm on the 25th of November from number 0 ********** .
Please let me know if this helps
Regards,
David
David Oliver ********** />
Dec 1 (11 days ago)
to Mohlago
Morning
I just realised i forgot to e-mail you what I originally wanted to. For got to add my conclusion
Conclusion:
In the voicemail left by buddy (assessor ) on the 25th. He stated that the main reason for my claim being denied is because I failed to comply with a reasonable request.
This request was access to my gmail to see my location ( a request that I proved was irrelevant as my location was last updated 12 days before my accident).
This holds all my personal information from banking to what i personally subscribe to which I don't wont in the hands of just anybody. Made even worse by hte fact that I had to log on with his device.
I explained this to both Buddy and Riaan and the POPI law that protects me in this case. Riaan then said that my location can be accessed via my network operator too. This alternative was not formally offered to me, by Buddy, when I said i would not like to give access to my personal information. Riaan's reasoning for not going via the network was that me, the client, wouldn't want to wait three months for the report back from the network operator. Once again I was not given the option as the client made assumptions were made without my input. I explained to RIaan, now after the fact, that actually I would have liked that offer as it means me holding on to my privacy. i asked then could that not happen and asked for the case to stay open, he's response was no.
The next point was that i **** on my claim, with regards to driving the car:
Once again with no proof that I **** and no actual investigation being done on whether a car can or cant drive on three wheels, an assumption was made based on your assessors opinion.
I Spoke to Riaan about this and after discussing it he admitted that we cannot conclusively say that a car can or cannot drive on three wheels after I had to investigate this point myself. I have provided a simple video for now to you, in my last mail, of a car doing exactly that.
Again, by your MiWay staff, I was presented with an alternative way of finding out the truth. In this case a reconstruction specialist to prove/deny my claim but once again when i said yes i would gladly do that. I was first told this by Riaan then later no by the claims manager, Francois. He is denying it straight out, after admittedly just hearing about the case as I called him and not knowing the full merit of my case. He's reason? Because he generally accept the outcomes of the cases from his assessors.
So as the manager not even bothered to **** interest in investigation the matter and coming back later with an answer of no. Can he at least pretend to care? But Like I said once again another alternative method to find the truth but refusal to do so.
I was forthcoming with my information and gladly helped along every way. Willing to provide facts, evidence and a witness (that was refused to ab admitted in by your assessor. everything i have stated here is a fact unlike your staff that has almost solely made decision based on assumptions (and what a tow truck driver told the assessor). They have denied me on numerous occasion a chance to prove my sayings as well discrediting my evidence by lying about me, saying I am an IT specialist and therefore any document i provide can be trusted.
I am truly appalled by the service received and I a not wanting this case re-opened ( I requested this enough) but would like a straight decision from you whether my claim outcome has been overturned or not.
i know i have a strong case as i have mentioned before that everything i have mentioned in my e-mails are facts and that is why I have requested my recordings, so if needs be my statements can be backed up should I need to take this matter further.
I have been driving for nearly 10 years now with no history of lying on any claim, in fact i'm pretty sure i have no claims. I have no history of ***** in my credit history. It was imp**** that being young means being dumb or making dumb decisions by your assessor (before seeing my car or looking at accident scene). i refute that. i did not get to where i am today because of being dumb or stupid. I don't help my father out with his mortgage and bills today because along the way to getting where I am I acted stupid. i don't have a degree with distinctions because I am a fool. Sorry that i digress but the treatment and level of respect i received by your employees infuriates me so much that you don't even understand.
Please note that I am not shouting or showing anger towards you in that last paragraph, was merely expressing my thoughts on what i experienced since meeting your assessor. I find it funny that my claim can be denied by your assessor because of his opinion that I must have **** on my claim but I have it recording of him lying that there are no marks where i said the accident happened and then saying yes there is a mark, lying about what i said I do for a living, lying that I didnt mention my witness before when i did but he never thought to ask, lying about me and my character in order to get an outcome in his presentation of the case in order to get to his predetermined verdict of what happened. Why is he allowed to lie?
"Freedom – what does it mean to you? At MiWay, freedom means the courage to be bold, to enjoy and savour priceless moments; to enjoy life on your own terms, free from worry and most importantly at peace with all the "what-ifs" of the world. We call this #insurancefreedom." you tell me if this is my experience thus far.
Regards,
David
This is the rest of the email correspondence:
Hi Mo
As discussed please see date below of interaction below for recordings request:
Buddy Vroom (Assessor)
First call: 22/11 @ around 2pm
then:
23/11 multiple calls (+- 7 calls) from around 11 am - 2 pm
25/11 multiple calls from 7 am - 12 pm
The meeting happened on the 25th of November, unsure of time
Riaan (Team leader) on the 25th: he called me on ********** ( I think this is the number) @ 12:17 pm
Francois Smit: Claims manager: called him at around 1 pm on the 25th of November from number 0 ********** .
Please let me know if this helps
Regards,
David
David Oliver ********** />
Dec 1 (11 days ago)
to Mohlago
Morning
I just realised i forgot to e-mail you what I originally wanted to. For got to add my conclusion
Conclusion:
In the voicemail left by buddy (assessor ) on the 25th. He stated that the main reason for my claim being denied is because I failed to comply with a reasonable request.
This request was access to my gmail to see my location ( a request that I proved was irrelevant as my location was last updated 12 days before my accident).
This holds all my personal information from banking to what i personally subscribe to which I don't wont in the hands of just anybody. Made even worse by hte fact that I had to log on with his device.
I explained this to both Buddy and Riaan and the POPI law that protects me in this case. Riaan then said that my location can be accessed via my network operator too. This alternative was not formally offered to me, by Buddy, when I said i would not like to give access to my personal information. Riaan's reasoning for not going via the network was that me, the client, wouldn't want to wait three months for the report back from the network operator. Once again I was not given the option as the client made assumptions were made without my input. I explained to RIaan, now after the fact, that actually I would have liked that offer as it means me holding on to my privacy. i asked then could that not happen and asked for the case to stay open, he's response was no.
The next point was that i **** on my claim, with regards to driving the car:
Once again with no proof that I **** and no actual investigation being done on whether a car can or cant drive on three wheels, an assumption was made based on your assessors opinion.
I Spoke to Riaan about this and after discussing it he admitted that we cannot conclusively say that a car can or cannot drive on three wheels after I had to investigate this point myself. I have provided a simple video for now to you, in my last mail, of a car doing exactly that.
Again, by your MiWay staff, I was presented with an alternative way of finding out the truth. In this case a reconstruction specialist to prove/deny my claim but once again when i said yes i would gladly do that. I was first told this by Riaan then later no by the claims manager, Francois. He is denying it straight out, after admittedly just hearing about the case as I called him and not knowing the full merit of my case. He's reason? Because he generally accept the outcomes of the cases from his assessors.
So as the manager not even bothered to **** interest in investigation the matter and coming back later with an answer of no. Can he at least pretend to care? But Like I said once again another alternative method to find the truth but refusal to do so.
I was forthcoming with my information and gladly helped along every way. Willing to provide facts, evidence and a witness (that was refused to ab admitted in by your assessor. everything i have stated here is a fact unlike your staff that has almost solely made decision based on assumptions (and what a tow truck driver told the assessor). They have denied me on numerous occasion a chance to prove my sayings as well discrediting my evidence by lying about me, saying I am an IT specialist and therefore any document i provide can be trusted.
I am truly appalled by the service received and I a not wanting this case re-opened ( I requested this enough) but would like a straight decision from you whether my claim outcome has been overturned or not.
i know i have a strong case as i have mentioned before that everything i have mentioned in my e-mails are facts and that is why I have requested my recordings, so if needs be my statements can be backed up should I need to take this matter further.
I have been driving for nearly 10 years now with no history of lying on any claim, in fact i'm pretty sure i have no claims. I have no history of ***** in my credit history. It was imp**** that being young means being dumb or making dumb decisions by your assessor (before seeing my car or looking at accident scene). i refute that. i did not get to where i am today because of being dumb or stupid. I don't help my father out with his mortgage and bills today because along the way to getting where I am I acted stupid. i don't have a degree with distinctions because I am a fool. Sorry that i digress but the treatment and level of respect i received by your employees infuriates me so much that you don't even understand.
Please note that I am not shouting or showing anger towards you in that last paragraph, was merely expressing my thoughts on what i experienced since meeting your assessor. I find it funny that my claim can be denied by your assessor because of his opinion that I must have **** on my claim but I have it recording of him lying that there are no marks where i said the accident happened and then saying yes there is a mark, lying about what i said I do for a living, lying that I didnt mention my witness before when i did but he never thought to ask, lying about me and my character in order to get an outcome in his presentation of the case in order to get to his predetermined verdict of what happened. Why is he allowed to lie?
"Freedom – what does it mean to you? At MiWay, freedom means the courage to be bold, to enjoy and savour priceless moments; to enjoy life on your own terms, free from worry and most importantly at peace with all the "what-ifs" of the world. We call this #insurancefreedom." you tell me if this is my experience thus far.
Regards,
David
Thanks for bringing this to our attention, we're sorry to hear that you are not happy with the outcome of your claim. We have passed your message on and someone will look into your claim and get back to you.
Best regards,
The MiWay Team
Thanks for bringing this to our attention, we're sorry to hear that you are not happy with the outcome of your claim. We have passed your message on and someone will look into your claim and get back to you.
Best regards,
The MiWay Team
We’re sorry that you’re not happy with the outcome of your claim.
We have since had another look at the claim and unfortunately our decision remains unchanged. We have also explained what to do if you’d like to dispute the outcome and we urge you to give us a call if you need any further assistance!
Kind regards,
The MiWay Team
We’re sorry that you’re not happy with the outcome of your claim.
We have since had another look at the claim and unfortunately our decision remains unchanged. We have also explained what to do if you’d like to dispute the outcome and we urge you to give us a call if you need any further assistance!
Kind regards,
The MiWay Team
No one has taken the time to reply to my questions:
1: It was said that my claim was denied because I refused access to my location. This is not true. I said that you cant acces my gmail and when offered I gladly accepted accessing my location through my service provider but then was told no you wont do that?
I never had a problem with you having access to my location. Im not going to give access to my gamail to a stranger while sitting on his device while in his car. Then I was told by the assesor tha i had to suggest going to my office to use my laptop. it's not my responsibilty to do that and your assesor asked me to meet in his car becuase he couldnt get parking close to my work.
This is the basis of your rejecting my claim and you have no basis. I was not offered the alternative to go to use my laptop or device or told that ok can we then contact your service provider.
I am also waiting on the recordings because I'm tired of this continued lie of me saying I'm an IT specialist and then your dispute officer said on the phone she heard me saying it on hte recording.
will there be repocussions for lying about me throughout this ordeal?
Regards,
David
No one has taken the time to reply to my questions:
1: It was said that my claim was denied because I refused access to my location. This is not true. I said that you cant acces my gmail and when offered I gladly accepted accessing my location through my service provider but then was told no you wont do that?
I never had a problem with you having access to my location. Im not going to give access to my gamail to a stranger while sitting on his device while in his car. Then I was told by the assesor tha i had to suggest going to my office to use my laptop. it's not my responsibilty to do that and your assesor asked me to meet in his car becuase he couldnt get parking close to my work.
This is the basis of your rejecting my claim and you have no basis. I was not offered the alternative to go to use my laptop or device or told that ok can we then contact your service provider.
I am also waiting on the recordings because I'm tired of this continued lie of me saying I'm an IT specialist and then your dispute officer said on the phone she heard me saying it on hte recording.
will there be repocussions for lying about me throughout this ordeal?
Regards,
David
We’re sorry that you’re not happy with the outcome of your claim.
Candice has since been in touch to discuss your concerns. She has also explained what to do if you’d like to dispute the outcome and we urge you to give us a call if you need any further assistance!
Best regards,
The MiWay Team
We’re sorry that you’re not happy with the outcome of your claim.
Candice has since been in touch to discuss your concerns. She has also explained what to do if you’d like to dispute the outcome and we urge you to give us a call if you need any further assistance!
Best regards,
The MiWay Team