Given that some, if not most of us, will at some point make claims on our insurance policies, it is important to be prepared when that moment arises to avoid any surprises or delays during the claim stage.
There is a general assumption that insurance claims are rejected by the insurer solely as a result of incorrectly completing a claim form. However there are many other reasons that could lead to your insurance claim being declined. In fact, Absa Insurance Company COO, Carike Van Dyk says a claim will not be declined for filing it incorrectly. “Claims are only rejected if any of the policy terms and conditions are not met, exclusion applies or if an event not insured occurs”. Instances where a claim on a home insurance, for example, will be declined include:
The property not being adequately maintained;
The use of the property changing from being a residential property to a business property. This is referred to as a change of risk;
Damages to the property occurring before the inception of the policy;
Damages to the property are not covered. An example is when an individual spills paint onto a carpet;
Late notification. Most insurance companies require that their clients inform them of any damages or possible claims within thirty days of the incident arising. Failure to meet this requirement might lead to the claim being declined and;
Sometimes in an effort to get claims accepted, individuals overinflate a claim, knowingly or unknowingly and this could result in the claim being rejected.
So how can individuals make the claims process as smooth as possible? According to Van Dyk, one of the most important factors an individual needs to consider is taking the time to fully understand the terms and conditions of his/her insurance policy as this could mean the difference between an approved claim or having to pay for damages yourself. “Don’t wait till you have a claim to understand your policy because there are certain obligations that are expected from both the client and the insurance company before a loss occurs,” Van Dyk warns