OUTSURANCE MAKES THEIR OWN RULES

I am shocked, appalled and disgraced by the service we have received pertaining to the claim number listed to the above on our commercial policy.

My claim was registered in January 2024 with our broker. Due to the value of our claim, I was referred on the claims assessor. The assessor visited my practice and the claims process was well underway.

I noted that I was going to be requesting our service provider for the abdominal ultrasound to make a trip to East London to run diagnostics on the machine to determine the exact cause of failure. The technician flew from Cape Town on Tuesday the 16th of January. He conducted diagnostics and determined which piece of equipment was causing the issue. Fortunately the part was in South Africa and could be delivered the next day. We requested the technician to overnight in East London and replace the damaged part the next day (17.01.2024) in order to spare expenses of back and forth travel for the technician.

On the 17th of February, the part was replaced and the machine was back in good working order. I requested the technician to please forward a damage report as well as tax invoice for the part which was received and sent to claims assessor 22.01.2024.

This morning 26.01.2024 I received feedback from Outsurance that they would not be covering my claim as it was due to ‘wear and tear’ on the device. – There was no mention of this in the damage report from the technician.

The assessor further explained that whilst the claim was being processed, he had spoken to a third party service provider – as to what may have caused the damage. The service provider (without seeing our machine or running diagnostics on our machine) was miraculously able to determine various causes for the break to occur. I now ask you, as the machine is provided and serviced by a specific service provider, how is the technicians damage report not sufficient in order for this claim to be processed and finalized?

I question the integrity of the third party as he has previously tried to discredit Outsurance by requesting my employee to hide certain information from claims assessor. I can only assume that it would be for the third party providers own financial gain to uplift the ‘broken parts’ from our practice, which were not in fact broken.

Again, I am unable to find reason for as to why a third parties opinion of damage has been overruled by the technician who is employed and trained to oversee such damages.

Every month, our premium is deducted without fail, we have insurance in place to avoid such costly financial losses but I find myself wondering if Outsurance is actually there to benefit their client or if they are in the market for their own financial gain.

I certainly will be shopping my policy should this claim not be finalized.