How far can the Ombudsman for Short Term Insurance assist? Is this the end of the road for me?

How far can the Ombudsman for Short Term Insurance assist? Is this the end of the road for me?

What is the purpose of the Ombudsman for Short Term Insurance? 29 October 2023 – I reported a claim at my broker, Carasure. I have insurance through them that is underwritten by Compass. Nature of the claim: Disintegrated wheel bearing on a Bush Lapa trailer. New bearings were fitted by Bush Lapa a year ago in February 2022 during a comprehensive service at the factory in Paarl. After a trip through Namibia with two stretches of terrible road we returned home safely without noticing any damage. It was only after a short week-end trip that we discovered damage. It was noticed before anything could happen that the wheel was busy coming off. Fortunately I stopped in time when I noticed the buckling wheel and prevented a possible accident. Unfortunately it seems afterwards that I should not have stopped but carried on until an accident happens - then the insurer would consider the claim in a positive light. The assessor visited my house and inspected the trailer and found the reason for the disintegrated bearing to be “wear and tear”. Afterwards when the axle was replaced at Bush Lapa we noticed a bend in the axle. The spindle was bent. The design of a needle bearing is of such nature that it can only run in one direction whereas a ball bearing runs in all directions. The application of a needle bearing is therefore restricted to axles and shafts that rotate in one direction like forward and backward. A ball bearing application is typically found in a front wheel driven car where the wheels must be able to move, up and down and sideways. In the case of an axle that is bent, the needle bearing is forced to move (slightly) in a direction that it was not designed for. Excessive friction and heat can build-up that can cause bearing failure. Over a couple of thousand kilometers from the Kunene River and Caprivi Strip to Cape Town - damage can happen due to a bend in the axle spindle. The terrible roads that we travelled on caused the axle to bend. The axle specifications on Bush Laapa was upgraded over time from a 1.8 ton axle to a 2.5 ton axcle. The axle on my trailer was still an old specification axle of 1.8 tons. It could have been damaged through some of the pot holes and poor road conditions. My insurer refused to accept my explanations and reasoning. 30 November 2023: I reported the matter to the Ombudsman for Short Term Insurance with photos and even a reference to a You Tube video that educates about the difference between ball and needle bearings and how damage can be done when an axle is bent. I have followed-up so many times now with the Ombudsman but to no avail. It seems if communication between myself and the Ombudsman has stopped now. I rejected the decision of my insurer and escalated the matter to the Ombudsman because I believe that my claim is an honest and valid claim. Below is the rejection and my reaction on the 6 statements made by my insurer with which I do not agree. Thank you for your communication to me. At this point I am rejecting the finding of my insurer on the following grounds: Number 1 The assessor noted that he could not find any impact to the wheel or the caravan that could have contributed to the bearing failure. The mail (attached herewith – last attachment on the list) with explanation and Youtube link with documentation about the technical operation of a needle bearing was not considered by the insurer. The insurer’s reply does not contain any information about it. I explained what probably happened when a sudden impact like hitting a pot hole could have had on the spindle of the axle – also on the bearing that carries the weight of the caravan which is then transferred onto the axle spindle. The photos of the axle was not commented on in the feedback that I received, neither was Bush Lapa consulted regarding this matter. The explanation also contains a photo of the axle that shows that it was bent and it must have happened during a sudden impact on the road and as explained – we travelled a terrible road in Namibia. Number 2 Bush Lapa (service provider) confirmed that due to wear and tear, the wheel hubs need to be replaced during the wheel bearing service. 1. I referred the independent assessor to Burquip, the axle manufacturer and to Bush Lapa. Bush Lapa was never consulted. I phoned them and I checked with them on 26 Jan 2024. I also instructed Bush Lapa to keep the damaged axle so that it is available for inspection. When the assessor visited me the damaged axle was still on the caravan and could not be inspected thoroughly. I visited Bush Lapa’s workshop afterwards when the axle was replaced with a new one and only when we turned the axle around we could observe the bended spindle of the axle. The axle is still available for inspection. 2. Bush Lapa never confirmed anything about wear and tear and was not consulted. This statement is therefore not correct. 3. Wheel hubs also do not have to be replaced during a wheel bearing service. I confirmed this with Bush Lapa. 4. Bush Lapa (Martin Appelgryn – Head of Service at Bush Lapa) was never consulted at any point by the insurer or their assessor, although I pointed the assessor to them. Martin Appelgryn confirmed his invitation to speak to him once again today (26 Jan 2024) – an invitation that I am passing on to the assessor and the insurer via yourselves once again. Number 3 The bearing failure was due to the weight ratio of the axles - the 1.8T axles are being replaced with 2.5T axles due to constant bearing failures on the 1.8T axles. This statement says nothing and is not true. Ratio means one measure expressed as a ratio versus another measure e.g. the ZAR USD ratio is in the region of ZAR20..00 which means one has to sacrifice ZAR20 for every 1USD. “Constant bearing failures”… do not know who said this. Bush Lapa explained the evolution from 1.6 ton axles to 1.8 ton axles to 2.5 ton axles to me but you can confirm that history with Martin Appelgryn. The complete statement is incorrect. Number 4 Damage to the wheel bearing is not sudden and unforeseen, instead a gradual process of wearing to complete failure. The bended spindle of the axle is unforeseen and therefore the damage was unforeseen. If a spindle can be bended then a bearing that “tries” to absorb the initial shock can also be damaged with the sudden shock effect of a pothole that was hit. I am rejecting this statement made by the insurer. Number 5 The assessor recommended that the insured direct this claim to the manufacturer/repairer that replaced the bearings in 2022 as the failure could also be as a result of poor quality bearing and the manufacturer should be held liable. I confirmed with Bush Lapa and one of the photos taken by the assessor of the failed bearings indicates that the bearings fitted by Bush Lapa during the Feb 2022 service were indeed SKF bearings – a well-known brand. Bush Lapa are also fitting Timkin bearings, also a product with a good reputation. The allegation of a poor quality bearing is therefore not justifiable. Bush Lapa has built more than 3300 caravans since its establishment about 13 years ago and the brand has a good name to protect. They are not using inferior parts. Number 6 In addition and by the insured's own admission, it was confirmed that several clients have complained about issues with bearing problems on a 1.8ton axle, which is what the insured had. As a result, the 1.8ton axle is being replaced by 2.5ton axles to combat such failures. This, in our view is a manufacture related issue. I have not stated that several clients complained about issues with bearing problems on 1.8 ton axles. I know that I should have been able to name such clients, something I am not able to do. I only furnished the assessor with information that I read on the 4x4 Community web page forum to show him what happened with other caravan owners who had bearing failures. It is a forum where subscribers can air their views and opinions. Nothing is tested and subscribers are not experts on bearings and axles. _______________________________________________________________________________________________________ I attach a previous communication to my insurer again for reference purposes. I do not think what I said was taken into account when the decision was taken by them to reject the claim. TO: • The Managing Director of Natsure Underwriting Managers • Compass Insurance Company Limited • Ombud for Short Term Insurance • The Compass Compliance Officer REGARDING CLAIM CARA 169548 I had an unfortunate experience on 29 October 2023, fortunately,... close to my house when I became aware in the rear view mirror of one of the wheels of my camping trailer (that is insured under your policy) that was about to fall out. I immediately stopped and when I lifted the trailer with its jack, the wheel fell out. Nothing secured it in place any more. The outer bearing completely disintegrated and the inner cone of the bearing heat-fused around the axle. It had to be cut off with an angle grinder. The disintegrated bearing and heat-fusing destroyed the axle and must be replaced. The bearing set was renewed in February 2022 by the Bush Lapa Factory and Service Centre in Paarl and the bearings was recently checked in May 2023 to ensure it was still lubricated enough. The bearing type was a SKF-bearing, a well known and reliable bearing brand. After the axle was taken off the trailer by Bush Lapa and replaced with a new axle I visited the Bush Lapa Service Centre and took pictures of the damaged axle. It is clear that the tip of the axle spindle is bent. I am the only person that can explain why the axle may possibly have bent: • At the beginning of June 2023 we visited Namibia and experienced very poor gravel road conditions in the West, especially between Aus and the Kuiseb Canyon. It was so poor that we decided to take a detour on our way to Swakopmund via Mariental. We turned Eastwards at Betta. We were a party of 3 vehicles. • Later on in our tour we went up to the Kunene River where we visited the Epupa Falls and we travelled from Opuwo to there. A dreadful distance of 180km that took us just under 6 hours. (Approximately 30km/h) The road was full of poor corrugation and potholes at places. We could not go fast but at more than one place I was perhaps too fast on a pothole. The road surface was full of lose gravel that made stopping or slowing down also challenging at times to prevent the vehicle and trailer from skidding. The problem on the Western side of Namibia is the number of foreign tourists that hire 4x4 bakkies and drive at high speed to their next destinations and they are ruining the roads. The graders cannot keep up to maintain the roads in good smooth condition. • The trailer’s unladen weight is 1100kg and I carried and additional 150kg water in the trailer’s water tank plus normal clothing, food etc. The total weight must be in the region of 1300kg. The vehicle axle specification is 1800kg which should be sufficient under normal road conditions. When one hit an unexpected deep pothole then that downward force of impact on the axle can easily exceed 1800kg. Compare it with someone who’s finger gets caught in a hamer stroke. A light hit versus a real hit can mean the difference between “Eina” and a bruised finger, depending on the severity of the downward force. • Bush Lapa explained to me that they are fitting 2.5 ton axles as a standard nowadays because of two reasons. The weight specification speaks for itself plus the weight of the trailer is distributed over a larger bearing size and circumference than what the case is with a 1.8 ton axle. My axle was still an “old school” axle of 1.8 ton. • Burquip, the supplier of axles to Bush Lapa was approached and they confirmed that an axle which is bent will only cause tyres to be worn unevenly but will not necessarily cause bearing failure. Something else must have caused the bearing damage. My theory of what happened is as follows: • I went through one or more potholes at the time of the Namibian tour and the impact on the axle was so severe that It not only bent the axle but it also damaged the bearing. One of the pictures shows the molten rollers of the bearing that fused together. One damaged or disintegrated roller in the bearing set is enough to jam the smooth operation of the other rollers in the bearing set and that could be the cause of the bigger damage. The disintegrated metal of one roller could form a grinding paste or metal pieces could become in the way of the other rollers and jeopardise smooth rolling. • Unfortunately one cannot hear the compromised bearing – far back on a trailer - like when one travels inside a vehicle where an audible “hum” sound is always present (a warning sign that one can act on) before a bearing gives trouble. • Fortunately we reached home safely after the Namibia trip. We never used the trailer sinse. About 6 weeks ago we visited Montagu and also returned safely. When we wanted to use the trailer again on 29 October I became aware of the trouble. If I went any further then I would have had more damage and that does not exclude the complete write off of the trailer because we were on our way to Citrusdal. Imagine that happens at 100km/h. When I visited the Bush Lapa factory to collect the trailer yesterday (29 November) I also noticed another trailer’s axle next to mine. This trailer also had a bearing failure. In this case I noticed that the complete outer bearing rim plus rollers were gone. he castle nut still in place as well as the inner bearing bushes. The general condition of that axle was poor. The leaf springs were rusted and the axle does not have any signs of lubrication. The owner lost the wheel, the brake baking plate is completely flat at the bottom where it hit the road and grinded away. No brakes any more. This person’s insurance covered his costs and even replaced his leaf springs. His lack of care for his trailer seemed to have paid off. I do not know who the insurer is and neither do I know the person. I just found it coincidental that the same thing happened with someone else as with me and but that other person was seemingly careless about his property and enjoyed full cover. In my instance, the axle shows signs of good care with an axle that is in a general good condition, still painted black, brake drums painted in silver to prevent rust – all signs of good care. On top of this, a new bearing kit was installed on both wheels a year ago in February 2022 by Bush Lapa. Prior to the June Namibia journey the axle and bearings were checked for sufficient lubrication and that the nuts were appropriately fastened on the leaf springs. How much more care could have been exercised? My timely observation of the situation also prevented further damage and a possible accident. Do I understand it correctly, does the policy wording of para 6.13 mean and imply that the insurer is not liable for damage unless an accident followed a gradual cause? This then means that if I proceeded with my journey until the wheel (“gradually”) fell off and I caused an accident, then the insurer would have accepted liability? If this is the implication, then I am quite concerned. I am therefore penalised for been cautious and observant. It does not make sense. The insurer was prepared to write off a trailer worth R400k with additional expenses such as tow-in charges, accommodation expenses if I was far from home following on a possible accidental misfortune that could stem from this - but they are not prepared to honour a claim worth a lot less stemming from a bearing that one cannot see easily, that failed and disintegrated, but on which preventative measures were taken to have it renewed in February 2022 as part of good maintenance. The policy also provides for Assistance with Mechanical or Electrical breakdown. I could manage to do temporary repair work to get the trailer safely at home from where the incident happened. I did not make use of the said benefit then. The axle was replaced by Bush Lapa in Paarl, 50km away. I included a quote for a tow-in or transport service with a flatbed truck with the initial claim. Noting was said about the claim for the transportation of the trailer to the Bush Lapa Service facility. Does this rejection also include the transportation costs to the Bush Lapa premises in Paarl? Why do I have insurance then – what is the use? I am not accepting the decision to have this claim rejected and I want a better understanding. I referred the assessor, Mr Warren Dietliffs, to Martin Appelgryn – Service Manager at the Bush Lapa factory and service centre and also to Pine Pienaar of WC Caravan Movers who has more information and experience pertaining to axles and bearings and repairs that they replaced before - but he opted not to consult with them. I think all knowledgeable resources were therefore not exhausted prior to the final decision to reject the claim. I am attaching the initial claims documentation for ease of reference. Please re-consider this decision. I am not satisfied with the decision and reasons given.