Insurance interrogated me

[Stonemason]

No I'm sorry, but you are completely wrong.

The principle of insurance being in good faith is what is tested at claims stage. If you have a valid claim you will be settled. If however you tried to work the system you will not get your claim paid. The problem is how farm some insurance companies will go to try and repudiate a claim. There is nothing wrong with checking factual data given when you took the policy. Like verifying who the regular driver is, was the person drinking before the accident happened if it happened 2am on a Saturday morning and no third party involved and so on. Insurance get's their money from admin fees and so on. The premium you pay goes into a book that needs to cover all insured people on that book. If your book has a positive balance it just means your premiums can be more competitive going forward and so on. Having a healthy book is the aim here. Repudiating a claim doesn't miraculously make an insurance company more money. It does make the book's loss ratio better meaning more benefits to those in the book.

That falls under the classification of using the model.

If no blood test have been taken by the police after the accident, there is no reason for an insurance company to try to determine if a person was drinking. Only repudiate based on what you can prove not based on what you think.

The model is to repudiate based on vague clauses because these companies know that most people will not take them to court.

The bottom line of these companies are dependant on how many claims they can repudiate.

Get yourself a company which looks for ways to pay your claim. Stay away from those who do not.

 

[Pitbull]

Outsurance have defended me at every turn. I still don't know where these horror stories come from

Years ago I was insured with them. I drove a Nissan STI. Stationary at a Traffic light (red) I got rammed from behind.

I take the vehicle to the assessment centre as I could still drive it. The Assessor looked at my tires and said one was bold. The inner side of the tyre as the wheel alignment was out wore and I didn't know it. They wanted to repudiate my claim due to my car having a bold tyre. After I was rammed from behind not even driving and no fault of my own. Then there was an issue of the excess being R 2 500 or something after the policy was sold to be with a fixed excess of R 1 000.

I cancelled my policy right there and then. I fixed the car myself.

about 4 years later they get a hold of me and say they recovered the money and repaid me the money the other party paid them for the damages (which I'm grateful for) But I will NEVER insure anything with them EVER again after that claim. Their loss though, I'm a pretty good client.

 

[Ho3n3r]

Outsurance have defended me at every turn. I still don't know where these horror stories come from

You will find horror stories from clients of every insurance company. I have seen the least from Outsurance - especially from a clients vs. complaints perspective.

 

[Pitbull]

That falls under the classification of using the model.

If no blood test have been taken by the police after the accident, there is no reason for an insurance company to try to determine if a person was drinking. Only repudiate based on what you can prove not based on what you think.

ofc they can. It's easy to verify if the driver was drinking by finding out where he came from and checking with the bar/pub/club and getting the receipts.

The model is to repudiate based on vague clauses because these companies know that most people will not take them to court.

Clauses added to protect other insured client's on the same book from people using their contributions for invalid claims and forcing them to have higher ratings year on year.

Clauses you accepted when you joined the insurance book

The bottom line of these companies are dependant on how many claims they can repudiate.

Get yourself a company which looks for ways to pay your claim. Stay away from those who do not.

They can only and will only repudiate claims which does not comply with the policy. So no matter how hard you try and see the wrong in it, repudiated claims are repudiated as it wasn't a valid claim. Simple as that. I will however agree that people make mistakes, even insurance companies and that is why we can escalate it to the ombudsman. But in the rare case an error is made the Ombudsman rectifies it.

 

[Pitbull]

You will find horror stories from clients of every insurance company. I have seen the least from Outsurance - especially from a clients vs. complaints perspective.

Only cause it serves their agenda.

Remember the Ombudsman report only shows ruling made against the insurance company. So if they have 100 questions they ask you and cover all their bases their overturn rate will be low. Doesn't mean they don't have complaints or less than anyone else. Just that their policy is air tight and no loop holes the client can claim against.

 

[Hemi300c]

I get the feeling something is not right as it's not normal for insurers in general to "deeply" investigate an accident where as "indicated" the TP is to blame and "unlicensed".

But remember some things.
1) You cannot approach the Ombudsman until you have written repudiation of a claim with full reasoning
2) You are privy to all recordings and documents
3) The TCF (Treat the Customer Fairly) rules and regulations are in play and although not 100% a law the insurers are expected to be operating in accordance thereto.

Yes the regular driver issue does come into play and is used to get cheaper rates however firstly the insurers accepted the premium and therefore the risk based on disclosures. If the circumstances were different or changed would they still have accepted the risk even if on a different rating scale.

And yes after many years in the industry I still today get disgusted at how some insurers go about their business and I am specifically pointing at the "direct insurers".

My advice is be honest and open, if not already, and let it roll they way they want it to and if not happy then approach the legal/Ombuds route. Don't sign or agree to anything detrimental to your indemnification.

But my strongest advice is for you to go through a reputable broker in the future.

PS also don't accept any advice from a Non registered and compliant Representative or Key Individual because the person giving the advice is actually acting illegally.

 

[Suspect99]

No I'm sorry, but you are completely wrong.

The principle of insurance being in good faith is what is tested at claims stage. If you have a valid claim you will be settled. If however you tried to work the system you will not get your claim paid. The problem is how farm some insurance companies will go to try and repudiate a claim. There is nothing wrong with checking factual data given when you took the policy. Like verifying who the regular driver is, was the person drinking before the accident happened if it happened 2am on a Saturday morning and no third party involved and so on. Insurance get's their money from admin fees and so on. The premium you pay goes into a book that needs to cover all insured people on that book. If your book has a positive balance it just means your premiums can be more competitive going forward and so on. Having a healthy book is the aim here. Repudiating a claim doesn't miraculously make an insurance company more money. It does make the book's loss ratio better meaning more benefits to those in the book.

Although. They should check all these things before happily accepting your money. Not after they have to pay out.

 

[Pitbull]

Although. They should check all these things before happily accepting your money. Not after they have to pay out.

I agree to a certain degree. There are things you can check (vehicle inspections)

The problem though is how do you check every little detail? That is why there is good faith in insurance. Which works for both parties if both parties are honest and open. The reason we have the FSB and all these regulations/legislations now. The Financial services sector used to do dodgy shyte and get away with it. But that is no longer the case. Or should not be in practice.

 

[Stonemason]

It may be easy to verify if a person bought alcohol (if you can somehow bully him into showing you his bank statement as some of the shady companies do) but you cannot prove that he was over the limit without a blood test.

What these shady companies do is they tell the poor claimant that he was automatically drunk if he bought alcohol even though they cannot prove it. They know that most of these people are young, inexperieced and broke and that they will never challenge them on it.

Do not try to defend these shysters. If you work for one of them, rather try to reform them and make them play nice with their clients.

 

[Ho3n3r]

It may be easy to verify if a person bought alcohol (if you can somehow bully him into showing you his bank statement as some of the shady companies do) but you cannot prove that he was over the limit without a blood test.

What these shady companies do is they tell the poor claimant that he was automatically drunk if he bought alcohol even though they cannot prove it. They know that most of these people are young, inexperieced and broke and that they will never challenge them on it.

Do not try to defend these shysters. If you work for one of them, rather try to reform them and make them play nice with their clients.

And you can buy alcohol on your way to a braai - if you weren't tested positive, doesn't mean jack. It's not illegal to buy alcohol, and unless they can prove you actually drank it in the car, they can get stuffed.

I don't drink, but talking from a drinker's perspective.

 

[Hemi300c]

And you can buy alcohol on your way to a braai - if you weren't tested positive, doesn't mean jack. It's not illegal to buy alcohol, and unless they can prove you actually drank it in the car, they can get stuffed.

I don't drink, but talking from a drinker's perspective.

It may be easy to verify if a person bought alcohol (if you can somehow bully him into showing you his bank statement as some of the shady companies do) but you cannot prove that he was over the limit without a blood test.

What these shady companies do is they tell the poor claimant that he was automatically drunk if he bought alcohol even though they cannot prove it. They know that most of these people are young, inexperieced and broke and that they will never challenge them on it.

Do not try to defend these shysters. If you work for one of them, rather try to reform them and make them play nice with their clients.

I suggest you read this for more information:-
https://www.iol.co.za/personal-finance/drunk-driving-warning-from-ombud-2007115

 

[MrGray]

Btw. Did you know it's standard process to search your social media profiles to see if there's anything that can be used to invalidate your claim.

Oh, it's much worse than that. One of the less obvious reasons why they all insist on trackers, and some even install their own monitoring systems (e.g. Discovery) is to enhance their ability to investigate claims. A typical scenario which I have personal knowledge of actually occurring - you roll your car at 2am in the morning - the tracker shows you were parked outside a bar until 1:30am. You claim you were just chatting with friends and didn't drink. The investigator pulls out your till slip and testimony from the waitron who served you 5 beers. Claim repudiated.

Probably a good thing from the perspective that it ensures that the claims of the honest can be paid, but still very unsettling the lengths they will sometimes go to. I know some industry insiders and apparently when there is a large claim, often while the people you deal with are all friendly and professional telling you they're "just processing your claim", there is a team of investigators in the background furiously trying to get dirt that can be used to refuse the claim, whether it is on social media or even actively interviewing service staff, friends, relatives, etc, sometimes very underhandedly.

 

[supersunbird]

Oh, it's much worse than that. One of the less obvious reasons why they all insist on trackers, and some even install their own monitoring systems (e.g. Discovery) is to enhance their ability to investigate claims. A typical scenario which I have personal knowledge of actually occurring - you roll your car at 2am in the morning - the tracker shows you were parked outside a bar until 1:30am. You claim you were just chatting with friends and didn't drink. The investigator pulls out your till slip and testimony from the waitron who served you 5 beers. Claim repudiated.

Probably a good thing from the perspective that it ensures that the claims of the honest can be paid, but still very unsettling the lengths they will sometimes go to. I know some industry insiders and apparently when there is a large claim, often while the people you deal with are all friendly and professional telling you they're "just processing your claim", there is a team of investigators in the background furiously trying to get dirt that can be used to refuse the claim, whether it is on social media or even actively interviewing service staff, friends, relatives, etc, sometimes very underhandedly.

Why is this "they all"? For clarities sake..

 

[maumau]

I was in a accident about two weeks ago /snip..............

He turned the conversation into a interrogation stating that he knows that I am the primary not the secondary driver and that he could prove it ,he wanted friends and family members numbers who could vouch my driving abilities ( point being what does that have to do with the accident ?) .After which he conveniently pulled out a document stating we would drop the claim (so he in turn would drop the whole primary/secondary driver case) .............../snip

What does that mean? Weren't you driving?

 

[Stonemason]

Oh, it's much worse than that. One of the less obvious reasons why they all insist on trackers, and some even install their own monitoring systems (e.g. Discovery) is to enhance their ability to investigate claims.

This is interesting, I have always wondered why my insurance company never asks me to install a tracker in a new car while everybody else claims that they cannot get insurance without a tracker. They obviously go for the cheap and nasty 'insurance companies'

 

[Pitbull]

This is interesting, I have always wondered why my insurance company never asks me to install a tracker in a new car while everybody else claims that they cannot get insurance without a tracker. They obviously go for the cheap and nasty 'insurance companies'

I will not insure with a company that has a tracking device as a requirement. Simple as that. It's not because of all these conspiracy theories. I don't want my car back once it's stolen or hijacked. That is it. Pay me and I'll go get a new one.

 

[Hemi300c]

Yes I can confirm that the vehicle tracking can be used as a investigative tool. And yes especially those incorporating their "own" systems into your insurance.

 

[Ho3n3r]

Yes I can confirm that the vehicle tracking can be used as a investigative tool. And yes especially those incorporating their "own" systems into your insurance.

These "save if you drive properly" trackers are the biggest scam yet. It's blatantly obvious that, if you're in an accident, they'll dig up that data and find something like "you didn't stop dead at a stop street 2 months ago" or "you drove 71 for 2 metres in a 60 zone a year ago", and subsequently invalidate a claim that way.

 

[xcaliber]

This is interesting, I have always wondered why my insurance company never asks me to install a tracker in a new car while everybody else claims that they cannot get insurance without a tracker. They obviously go for the cheap and nasty 'insurance companies'

And that insurance company is

 

[Stonemason]

And that insurance company is

Santam