Rejection of claim - storm damage to roof and house

I wrote this letter to Outsurance:

With reference to the rejection of claim Outsurance communication sent on 2 February 2023 for Policy Number: OT*** Claim Number: ***

I must express my shock at the rejection of my claim and extreme disappointment with Outsurance at the handling of this claim right from the beginning.

My claim was for damage to my roof, my ceiling and facia wall, and other items caused by an extraordinary storm on 8 November 2022, when Johannesburg was struck by hail, extreme winds and flooding. I’m sure you as an insurance company would have been acutely aware of the widespread damage that was caused in Johannesburg on that date. (I have provided the necessary video footage to yourselves). It was extraordinary (or sudden and unforeseen) because my roof has not leaked once apart from the 8th November, despite unprecedented rain in Johannesburg since October 2021, where my roof was repaired after a claim with Outsurance, and hasn’t up until today.

I vehemently object to your rejection on the basis you describe:

- Wear-and-tear and breakdown - any cause that was not sudden and unforeseen - gradual deterioration, including rising damp, wear-and-tear, rust, mildew or fading.

That is not my only objection.

As one of South Africa’s leading insurance agencies, Outsurance purports be professional, speedy and customer facing. I have never seen such unpleasant, ***********, inefficient service in the handling of a claim, including the aspersions you have alluded to on my character.

Here is why.

I duly submitted a claim on 12 December after numerous failed attempts to do this electronically on the website. I received acknowledgement of my claim from your advisor Cate Mhlanga on 14 December. An assessor was appointed on the 15th from was appointed and arrived on 20th to assess the damage, after postponing twice due to a vehicle breakdown and inclement weather. They could only assess the interior as he didn’t have a long enough ladder to check the damage to the roof. The second time took 9 days for him to come back with a ladder to access. This takes us to 29 December. I obviously presumed the assessment was duly delivered to Outsurance.

On the 30 December I received the following notifications on both messages on my phone and via email:

Please note that the estimated completion date of repairs to be done by service provider MEC MAINTENANCE (PTY) LTD is 16/01/2023.

Then on 13 January I received this:

Please note that the estimated completion date of repairs to be done by service provider MEC MAINTENANCE (PTY) LTD is 23/01/2023.

Then after calling OUTsurance I received this on the 23rd January.

Please note that the estimated completion date of repairs to be done by service provider MEC MAINTENANCE (PTY) LTD is 27/01/2023

On the 26 January, this I sent a mail asking if this was the confirmed and received this.

Please note that the estimated completion date of repairs to be done by service provider MEC MAINTENANCE (PTY) LTD is 03/02/2023.

On the 2nd February this

Please note that the estimated completion date of repairs to be done by service provider MEC MAINTENANCE (PTY) LTD is 09/02/2023.

Anyone of your customers would have presumed from these communications that the claim had been approved and was underway, despite the lack of communication or follow up for months.

I eventually called Outsurance on the 2nd February to find out if the approved contractors were going to arrive on that day, as promised for the 5th time. I was helped by Boitumelo who could not find anything on my file from the assessor and promised to follow up, and was eventually called back by your claim consultant Thabang Boitelo.

He informed me that he would submitting my claim and the assessors report and would then call me back. I was incredulous that after all months of communication it was obvious that only that morning my claim had been submitted even after all the above communication I had received.

On the 2 February, the very same morning, just after the call, I received communication that the repairs would be completed by the 9th. Also, the very same day I received the communication that my claim had been rejected.

It gets worse.

I was astounded when Thabang called me back to let me know that my claim had been rejected, and I obviously asked on what grounds. I was told the following. That I had neglected to maintain my roof. I explained that the roof had been repaired by Outsurance in October 2021. He said it was written into every Outsurance contract that every customer of Outsurance had to prove maintenance of their rooves every 6 months and my roof was obviously a case of negligence. I asked why that hadn’t been explained to me or how my previous claim in 2021 was approved, he rep**** that Outsurance has made a ‘concession’ on my previous claim and that “Outsurance had decided not to ‘punish’ me for my neglect. He also said the roof tiles were very old. I reminded him that the roof leak was from an extension that was completed in 2018 and that there were no tiles on that part the roof.

I was also informed the rejection of the claim would include, not only the roof, but also all the interior damage the leak caused to the ceiling, facia wall and other damage, so the previous approvals therefore were null and void.

I resent the aspersions cast by your rejection of my claim. Firstly, that I was negligent, secondly that you had given me a ‘concession’ on a previous claim, and thirdly by implication that I was guilty of a crime for which I might be ‘punished’, which can only be interpreted as an effort to de***** Outsurance. This after a prolonged continuous mismanagement and miscommunication.

I have been a client for decades and during this period I have claimed twice prior to this claim.

Rest assured that, no matter what the outcome, I will spread this far and wide. Your behavior as a respected Insurance company has been unacceptable and extremely hostile.

Robert Mc Lennan