Ensure your claim gets paid

Understand your insurance contract. To avoid a situation where your claim could be rejected, familiarise yourself with the following reasons, but also make sure that the terms and conditions are reviewed regularly.

The following is very important to ensure a claim is paid:

•     Wear and Tear and Maintenance – Your insurance policy is NOT a maintenance contract. General upkeep of your property or items is NOT covered. For example, tree roots cause damage to pipes, drains, paving, walls. Your motor vehicle must be serviced annually.

•     Defective workmanship/ materials used – If an inferior product or item is used to do repairs, the insurer will not pay your claim. The service provider must also comply to regulations and must be qualified to do the work.

•     No cover – The policy does not provide the cover for this event or item. Cell phones must be specified to enjoy insurance should there be a claim or car hire might be excluded on the motor section.

•     Non-Disclosure – Notify your broker or insurer of relevant changes that may increase the risk of acceptance for the policy to respond to may result in your claim being rejected. For example, your child will be driving your vehicle.

•     Late notification – The client has 30 days to report a potential claim. Failure to do so may result in a rejection.

•     No insurable interest – The interests of all parties must be noted on the policy for their respective interests to be covered. If you do not have financial interest in an asset, you cannot insure it. For example, the registered owner of a car must note on the policy.

•     Unpaid premiums – If the debit order return due to lack of funds, a claim will only be considered after settlement of the outstanding premium. If you place a stop order on your short-term insurance debit, this will result in an immediate cancellation and no cover will exist as your intention was not to pay the premium.

•     Misrepresentation, dishonest or criminal behavior – All these could draw serious consequences for the Insured, to the extent that they could be blacklisted and may not be able to obtain insurance. In the event of fraud, misdescription, misrepresentation or non-disclosure of material facts, the insurer could cancel the policy with immediate effect or declare the policy null and void from inception date, resulting in the claim being rejected.

Very few people read through the fine print in their insurance contracts, which differs significantly between policies and insurers. In some instances, it's only when you submit a claim, that you learn about a missed clause, excess, or an exclusion.