1 reviews | Active since Apr 2018
LTC/ OUR REF: K83/18H
LTC/ OUR REF: K83/18H
We laid a claim against the insurer and the ombud sided with them based on their PROBABILITIES YET the insurance company had the very information which the claim is being rejected on at hand from the very start of the policy which they deducted money for up untill the day of the accident by means they accepted the policy but when I wanted to claim they used that exact information against me not to pay out? I'm sure there is a law against that is there not?
Dear Mariette
I have reviewed your file and agree with the decision made.
Short-term insurance is a contract entered into on the basis of good faith and it is your responsibility to disclose all material facts that may be reasonably expected to enable the insurer to properly assess the risk.
Having regard to the sales conversations and the evidence of the witnesses, the insurer has sufficiently argued a case to contest liability under the policy on the basis of a material misrepresentation of the details of the regular driver. In these circumstances, the insurer is entitled to void the policy from inception and refund your premium. There is unfortunately no basis on which this office can justify a decision in your favour.
Our file in the matter remains closed.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman
Dear Mariette
I have reviewed your file and agree with the decision made.
Short-term insurance is a contract entered into on the basis of good faith and it is your responsibility to disclose all material facts that may be reasonably expected to enable the insurer to properly assess the risk.
Having regard to the sales conversations and the evidence of the witnesses, the insurer has sufficiently argued a case to contest liability under the policy on the basis of a material misrepresentation of the details of the regular driver. In these circumstances, the insurer is entitled to void the policy from inception and refund your premium. There is unfortunately no basis on which this office can justify a decision in your favour.
Our file in the matter remains closed.
Kind regards,
Ayanda Mazwi
Senior Assistant Ombudsman