Plumber Moses Hans’s bakkie was “totalled” when an OUTsurance client crashed into it.
OUTsurance rejected the Burgundy Estate man’s claim, because, they said, the other driver got sick behind the wheel and the accident was beyond his control.
Mr Hans and his wife, Marion, told OUTsurance that the crash on November 3 in 2014, was caused by their client, Mr G M.
“The claim was handed over to Theresa Chateau a few days later with all the documentation and we asked for feedback. When none was forthcoming our legal representative contacted Ms Chateau who told him nothing would come of the claim,” Ms Hans said.
“Ms Chateau confirmed that the matter had been referred to management because the client has a medical condition and she didn’t know if we were entitled to claim (under South African law). I told her we did not have any insurance because we bought the vehicle a few months ago and once it was transferred to my husband’s name, we would get the vehicle insured. Ms Chateau told us we were a high risk on the road and we are very careless by not having an insured vehicle. Their client was an even higher risk on that day due to his illness,” said Ms Hans, who found it strange “that your client has been sorted out already while we are losing business by the day”.
“Your client, who smashed into my vehicle, admitted he was not feeling well after the doctor changed his medication the previous day. How negligent is he for getting behind a wheel of a vehicle?” Ms Hans asked.
“Our livelihood is at stake here and I think it is highly unethical of your representative to treat a third party – and a potential client – in the manner she did,” Ms Hans told Jeanine Portela from OUTsurance, when she complained about the claim being rejected.
Ms Portela said the client’s vehicle is repaired under a contract and if the documentation is provided and they have fulfilled policy conditions, they settle the claim.
“Your claim is a legal matter and certain legal requirements need to be met (well, their client’s claim is also a legal matter), so you cannot expect the same time frames. Our time frame is six to eight weeks to enable us to properly investigate the claim and obtain further documentation from our client that is required for the legal process. She (Ms Chateau) has been more than reasonable and has in fact attempted to resolve the matter sooner by obtaining the required info from our client at earliest convenience.
“We will be rejecting your claim as our client suffered a medical emergency. This constitutes a sudden emergency. Our client took ‘her’ required medication on the day of the accident, and has not had previous incidents similar to this. It would therefore be unreasonable to state that our client posed a known risk and was negligent as at the time ‘she’ was driving she could reasonably expect that ‘her’ condition is under control as all the required medicines were taken,” said Ms Portela who added: “I will have Ms Chateau send you the formal rejection letter, and you may address same either by providing supporting documents for your claim (if you can prove otherwise) or litigation if you deem best.”
So that’s call centrespeak: they don’t even know that the client is a male. In plain English, OUTsurance rejected the claim because the client had not been involved in similar incidents nor was “she” a medical risk.
“Our core responsibility remains to acting (sic) in the best interest of our client,” Ms Portela said.
“Please help us,” Ms Hans asked me.
But OUTsurance changed their mind after I spoke to them last week. Spokesperson Natasha Kawulesar, said they immediately settled their client’s claim as he was comprehensively insured with OUTsurance.
“Liability cover, which is cover where our client damages another party’s property, is part of our comprehensive vehicle cover. For us to settle a third party’s claim our client would need to be legally liable for the accident. Our initial view on the third party claim was that our client was not legally liable for causing the accident. This is in line with South African case law and also how other insurance companies would have treated us if we tried to recover money from them in such circumstances. As such we did not compensate the third party in this claim,” Ms Kawulesar said.
“Having reviewed the matter carefully, we have decided that some liability may have attached to our client as he was not feeling well on the day of the accident after having changed his medication. As such we will be settling the matter and will be in contact with the third party,” she said.
And so it happened. “Yes, I accepted the offer of R42 000,” Ms Hans said a day or two later.
Ms Kawulesar urged all motorists to buy comprehensive insurance as it is “the only way to ensure that you are properly covered for incidents like this”.
“More than 50% of drivers on our roads are not insured, which may leave you exposed to significant financial loss if you’re involved in an accident – whether it was your fault or not.”