What is an Excess?
An excess is the first amount payable, which is your responsibility, in the event of the submission of a claim. It is the uninsured portion of your loss and is payable regardless of whether or not it was your fault. It serves to deter clients from submitting minor claims and/or fraudulent claims, thus keeping premiums down. It is important to note that the excess covers the first portion of the loss and that it is not a pro rata sum. The practical implication of this fixed amount is that if your total claim is less than the excess amount – you will have to pay for the excess first, meaning that you pay for the entire claim amount.
What is Excess Buster?
Excess Buster means that the Basic Excess payment provided in the Policy Schedule will be waived in the case of a claim, but any other excess payment specified in the Excess Schedule will still remain applicable. Excess Buster will only be applicable to the insured, and the insured must be 30 years or older, must be insured for 5 consecutive years and must already be claim free for a period of 5 years
Who is the Insured?
The Insured is the person named in the Policy Schedule and includes his/her spouse as well as family normally living with him/her and financially dependent on him/her.
What is "Average" and when is it applicable?
Average means that you will be responsible for a proportional share of the loss or damage, as a consequence of not being adequately insured.
Average is only applicable to claims under the Building and Contents sections of the Policy, as claim settlements are based on replacement values, which means "new for old".
If according to our calculations, the amount needed to replace all your private residential structures with similar or new structures at the time of any loss or damage, or the amount needed to replace all your household contents with similar or new property, is more than the insured amount, we will not pay you for the full amount.
Example:- If you are insured for R500 000, but the replacement value of the property is R1 000 000 you are only insured for half of the replacement value and you must cover the other half. If you suffer a loss in the amount of R100 000, we will only pay half of this amount, which is R50 000.
What is "Insurable Interest"?
You may only insure your own personal items under the policy and not items belonging to your friends or family, unless you have a financial interest in such item. The latter must be disclosed to us and we must agree thereto in writing. For example, if you pay for a vehicle that is registered in someone else's name, it must be disclosed to us in order for us to decide whether we are prepared to accept the risk or not.
What should I do if I am in a motor accident and know/think that I am guilty?
Never in any circumstances admit guilt, or even apologise if you think you are guilty. The reason for this is that you may prejudice our rights, in which event we will be in a position to reject your claim. You may never make any admission, statement, offer, promise or payment without our written consent. Our Legal Department will establish whether there is liability or not.
What can happen to me if I submit a fraudulent claim?
Any form of fraud is viewed in a very serious light and criminal action will be instituted against you. We employ highly specialised investigators in this field and any such conduct will be uncovered.
Fraud is rife in the Insurance Industry, which leads to increased premiums. If you claim for an item you did not own, or that was not stolen or damaged, or request a panel beater to "work" your excess into a quotation, it constitutes fraud.
If any part of a claim is fraudulent, the whole claim is deemed to be fraudulent. The claim will be repudiated and legal action will be taken against you.
Will my claim be paid if I am involved in an accident under the influence of alcohol?
No, your claim will not be paid. We will not accept any liability arising whilst the driver of the vehicle is under the influence of drugs or intoxicating liquor, or whilst his blood alcohol level exceeds the legal limit.
What are some of the reasons for the repudiation of a claim?
If the driver of a vehicle was under the influence of drugs or intoxicating liquor, or whilst his blood alcohol level exceeds the legal limit, a motor accident claim will be repudiated.
Motor accidents occurring as a result of an un-roadworthy vehicle will be repudiated. The most common reason for the repudiation of claims is as a result of smooth tyres.
If your premiums have not been paid, this could result in no cover being in place at the time of your claim.
Non-disclosure or misrepresentation of material facts could result in us voiding your policy and we will not be liable for any loss, damage, injury or liability. You have to disclose your full claims history to us, as our decision to accept or decline the risk and calculation of your premium is based on this information. You must tell us of all details relevant to the risk we are insuring.
If you do not comply with the security requirements, as stated in the Policy Wording and reflected in your Policy Schedule your claim will be repudiated. If you have declared the existence of any precautionary measures (including house alarms, vehicle immobilisers and tracking devices) cover is dependent on such measures and you must ensure that they are in place and working properly at the time of loss or damage. You are responsible for ensuring that agreements with service providers are maintained.
If you are unable to provide proof of ownership by way of purchase invoices and valuation certificates your claim could be repudiated.
If you have no "insurable or financial interest" in an item you have insured, your claim could be repudiated.
Fraudulent claims will not only be repudiated, but will also result in prosecution.
Items not insured will obviously result in no cover and no liability will be accepted.
Certain items like; mobile communications devices, car radios, cameras, laptops and jewellery must be specified, under the All Risks section of your Policy to enjoy cover.
What is meant by recovery or subrogation?
This is a service we offer whereby we endeavour to claim back the costs of the damages that were sustained to your vehicle, where another party was at fault. Our full outlay, including your excess, will form part of the recovery.
What about my Excess, in the event of a claim?
The Excess amount is the uninsured portion of the loss and there is no guarantee that this amount will be refunded to you unless we are successful in recovering it from the other party.
When you apply for insurance and on entering into the contract, you sign over your subrogation rights to us. In other words, you give us the right to take over and conduct in your name the defence or settlement of any claim and take proceedings at our own expense and for our own benefit to recover any payment we have made, which includes your Excess.
You may under no circumstances enter into negotiations with the other party regarding settlement of the claim or, if offered, accept only your excess, as that would prejudice our rights. In such circumstances, we will have right of recourse against you and we will hold you liable for the full costs of our outlay.
Should we decide not to exercise our subrogation right or decide that it is not economically viable to proceed with the recovery, only then do you have the right, if you wish, to act against the other party, but only for the amount of your Excess.
How long can a recovery process take?
A recovery can take anything from three months to three years. There is no definite or specific time frame that can be guaranteed. Factors such as the accuracy of the information provided regarding the other party and the co-operation or lack thereof from the other party or his/her Insurance Company, will ultimately determine the timeframe of a recovery process.
What is the difference between a recovery and a third party claim?
A "Recovery" is when you were not at fault for an accident and we act on your behalf to claim the damages from the Third Party.
A "Third Party Claim" is when you were at fault and the Third Party is claiming against you for damages.
If my recovery is abandoned, do I have any other options to claim my Excess?
You will be notified if a recovery is abandoned and the reasons therefore. You will then have the option to issue Summons against the Third Party in the Small Claims Court for the excess amount only providing it is less than R8,000. We will make all the documents available to you for this purpose.