tM
thabisile M

1 reviews | Active since Jun 2018

30 Jun 2018, 05:12

damages inflated and grounds for rejecting claim invalid

In May 2018 on Saturday got involve in accident on my way home with my husband, we submitted a claim to outsurance on Monday, the claim advisor informs us that it will take 48 hours to assess the damages to the car, I got a call from outsurance legal department saying the car is a write off to which I ask how is it a write off if the airbags didn’t come out and the damages are not that much, I was told that the cost of fixing the car exceed the write of threshold. I ask for the assessor report 4 times which in the end was provided to me and sent an email to the claim manager informing him that the quotation was inflated and some of the parts included in the quotation, he responded saying he will provide me with feedback, which to date he has not. they conducted their investigation , and the investigator kept asking who was the driver on the day of the accident, they even went and ask neighbours who is driving the car more regularly ,mind you were are very private people don’t discuss our family issues with neighbours, they didn’t even know that we had an accident .they ask for beacon report, bank statements, the claim was rejected because the beacon reports, we had two cellphones, the other cell phone say location undefined, outsurance rejected the claim saying I was not the driver and I ask who was the driver the investigator say he interviewed the driver who tow the car and he said we told him that the accident happened somewhere in R21 and my husband was driving, I told him when the car was towed I was with my husband and the only thing the driver said was that we are lucky the airbags didn’t come out. I was the driver on the day on the incident and my husband is a regular driver of the car, so why will I claim that I was driving the car when I was not, Vodacom was establish purely for communication not to track locations and insurance is using them to reject claims.so much reliance if placed on telecommunication which the insurance don’t have control of how are the system of Vodacom are run, Vodacom is not even aware that they should be tracking the location of insurance client because when you get involve in an accident ,they use the telecommunication as their line of defence ,I ask for all the recording of the interviews conducted and the investigators say he need to present his findings to the National claim meeting and will give them to me ,he gave me a call and said he will reject my claim and letter of rejection was send to me, I wrote an email requesting the recording he rep**** saying I need to write a request ,didn’t even give me the details who should I request it from ,which I was surprise because my email serve as a request i disputed the rejection ,in terms of outsurance complain resolution part 3.3 quoted below 3.2 Our responsibilities: The person dealing with your complaint will: • Acknowledge receipt as soon as possible, but not later than 24 business hours • Confirm their contact details to you; Identify all issues by considering all concerns or points raised and asking additional questions if necessary • Do comprehensive research into causes of all the issues raised • Handle complaints in a fair, transparent and timely manner • Resolve the complaint within 15 working days, provided we have all required information • Provide feedback at least every 10 days • If we require further information, assessment or investigation, we will agree with you on a reasonable timeframe; • In the event that the person handling the complaint finds it impossible to reach an agreement, the matter will be escalated internally for a dispute resolution process. I disputed the claim on Friday,didn’t get acknowledge receipt within 24 hours .On wedsday I sent an email to the claim advisor that I sent an email disputing the claim rejection and didn’t get a respond ,she rep**** and said forward me the email so that I can forward it to the relevant manager that was 12.22p.m ,I forwarded the email to her. At 12 58 p.m I got a response from the same claim manager who was handling the claim saying the decision remain unchanged, according to my understanding of the resolution the claim should be handle by an independent person, the person should investigate all the fact stated in the dispute before providing a decision ,which in my cases did happened My policy was cancelled and the outsuarance have already deducted for June and send me a letter saying they will refund me after 30 days, why after 30 days because I need that money to pay for the new insurance since I no longer have a contract with them, the investigation was dragged so that they can deduct after cancel the policy I got a quote from the panel beater for the damages in the car and the quotation is R100 000 less than what the assessor report indicate the damages to prove that the damages In the car were inflated and outsurane didn’t act in good faith When you add a second car in the policy they don’t explain to you that when you claim for one car you will lose your out bonus and that is material non-disclosure of information to the client because if that information is disclosed to you it will influence the decision making and you will have two separate insurance policy, to my surprise the premium is deducted per car and the repairs are done per car so why lose you out bonus for a car that has been claim free for three year I had so much respect for outsurance and thought it’s a big company who handle claim professional and have respect to their customers but it just a dream none of those exist that you always get something out, You are given respect when they go to your bank and deduct the premium but come claim time you are treated as an enemy and they are not transparent at all The assessor are inflating the cost of damages to the car so that it can be a write off and the insurance can sell it ,that’s committing ***** because you can’t write off that is not a write off, insurance insurance should consider involving panel beaters during their assessment so that they can the actual cost of the damages because panel beaters are the one that fix the car in the end ,question is how many car has been written of when they should have been fixed and can outsurance improve his transparency and provide the information when you request it ,the same way we do when something is requested from us Outsurance must refund us our premium and repair the car because at the time of the accident we were insured with them

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Replies (1)
OUTsurance
OUTsurance's reply05 Jul 2018, 13:31
Official

Hello thabi22

We fully understand your disappointment and not at all insensitive to the financial loos you are incurring as a result of the rejection of your claim.

After having notified you of the rejection and having received your complaint, we sent you detailed communication as to why we will remain with our decision to reject the claim. The discrepancies were stipulated and your right to approach the offices of the Ombusdman were confirmed.

Regards

OUTsurance