Interesting insurance claim question

Archer said:
I've become aware of an interesting claim that is in the process, and I was wondering what the opinions are about it...

Driving along on gravel roads and somehow (whether driver error or poor roads) you get a hole in your crank housing and you lose some oil. Due to your location and time of day you feel unsafe abandoning the vehicle and proceed to drive slowly to a place where you are able to be towed the rest of the way to your destination (a small town). At no point do any any warning lights come on. You then proceed to do a field repair to close the leak (pratley steel), drain the oil and refill. You test it on a short drive and all sounds normal (and no oil leaks) but at some point the engine sounds change and you immediately stop (still no warning lights). Vehicle gets towed back to the small town and the dealership fetches it form there a few days later.

At the dealer they have a look and say a new engine is required... so should insurance pay for the engine or not?
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as far as i know, insurance wont cover mechanical damage ( not caused by an accident) thats why they give you road side assist,
 
Archer said:
I've become aware of an interesting claim that is in the process, and I was wondering what the opinions are about it...

Driving along on gravel roads and somehow (whether driver error or poor roads) you get a hole in your crank housing and you lose some oil. Due to your location and time of day you feel unsafe abandoning the vehicle and proceed to drive slowly to a place where you are able to be towed the rest of the way to your destination (a small town). At no point do any any warning lights come on. You then proceed to do a field repair to close the leak (pratley steel), drain the oil and refill. You test it on a short drive and all sounds normal (and no oil leaks) but at some point the engine sounds change and you immediately stop (still no warning lights). Vehicle gets towed back to the small town and the dealership fetches it form there a few days later.

At the dealer they have a look and say a new engine is required... so should insurance pay for the engine or not?
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Short answer. NO

However, it will depend on your insurer. Your vehicle was fine prior to driving it again after the "fix" Should have just called a towing company there and then.
 
Hemi300c said:
Firstly check your policy wording and you'll find the following under exclusions and policies differ and some say damage to the vehicle, some say damage to the suspension Example as follows:-
NOT COVERED BY THIS SECTION
1. VEHICLE LOSS OR DAMAGE
None of the following are covered, unless shown otherwise on the Schedule:
1.1 mechanical, electric or electronic breakdown, failures or breakages, including any consequential loss of
or damage to any other mechanical, electrical or electronic component as a result of the mentioned
breakdown, failure or breakage;
1.3 gradual damage (such as wear, tear, rust, mildew, corrosion, decay);
1.4 damage to tyres by the application of brakes or by punctures, cuts or bursts caused by road hazards;
1.5 damage to the suspension system due to unevenness of the road or other surface or due to impact
with such unevenness;

So I suggest refer to your broker/insurer because there are slight or even major differences in Insurers Policy wordings and never take it for granted if one insurer does this the other will.
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This. Exclusions are stated in your policy documents.
 
Hemi300c, Pitbull and genetic are right. It all depends on what sort of an insurance agreement you have with your insurer.

Without knowing that, there's simply no way to tell.
 
Pitbull said:
Short answer. NO

However, it will depend on your insurer. Your vehicle was fine prior to driving it again after the "fix" Should have just called a towing company there and then.
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So insurance doesn't need to prove that critical damage did not occur in the initial accident? Or in the subsequent compulsory short ride to an area where towing was possible? That's the issue for me
 
Insurance doesn't need to prove a single thing. Insurance wrote the 30 page policy document that you signed, and you don't think all those carefully worded clauses are there to protect your interests do you?
 
Colin62 said:
Insurance doesn't need to prove a single thing. Insurance wrote the 30 page policy document that you signed, and you don't think all those carefully worded clauses are there to protect your interests do you?
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:rolleyes:
Ya sure bud, insurance doesn't need to prove anything. They can just claim you were drunk and refuse payment.
 
Archer said:
:rolleyes:
Ya sure bud, insurance doesn't need to prove anything. They can just claim you were drunk and refuse payment.
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Indeed they can. Then if you are sure they are wrong you can take them to the ombudsman and they would need to provide proof for their decisions (eye witness statements, bank transaction statements, etc.)
 
supersunbird said:
Indeed they can. Then if you are sure they are wrong you can take them to the ombudsman and they would need to provide proof for their decisions (eye witness statements, bank transaction statements, etc.)
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Uhm... ok... so they do need proof.
 
Archer said:
Which is a far shot from the ludicrous statement that they don't need to prove a single thing.
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No need to be a chop. My statement that they don't need to prove anything was quite clearly a reply to your question on proving when the damage occurred to your car.

And if you were drunk at the time, you should have told us... :)
 
Easy answer, when in a situation call the Insurer's 24/7 assist or help line and they will advise as to what to do and then the pressure is off you and on them as all calls are recorded.
 
Hemi300c said:
Easy answer, when in a situation call the Insurer's 24/7 assist or help line and they will advise as to what to do and then the pressure is off you and on them as all calls are recorded.
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And when far outside of cell reception as was the case here?
 
Then you make the correct decision at the time and hopefully you have a good broker to assist with the claim.
Every case has it's merits and one cannot do a policy that describes and clarifies every situation and it's covers and exclusions.
 
At OP (I am busy with some short-term insurance issue): You might want to contact www.osti.co.za if you are not happy with the response from the insurer. Have a look at page3 in this report which covers aspects of consequential damage where the insurer initially refused to settle.
 
Claim approved in full ;)
Basically insurance wouldn't budge on the consequential damage, regardless of the circumstances of this specific incident. However after much insistence, they were convinced to actually open the engine (instead of make conclusions based on engine oil contents alone) and damage was proven to have resulted in the initial accident. Oh, and the field repair was oddly enough never an issue, go figure :confused:

I'd still like to know what would happen in a more imminent life threatening situation where you knowingly damage your vehicle in order to protect yourself. I really do hope the "reasonable person" test would see the claim approved.
 
Archer said:
Claim approved in full ;)
Basically insurance wouldn't budge on the consequential damage, regardless of the circumstances of this specific incident. However after much insistence, they were convinced to actually open the engine (instead of make conclusions based on engine oil contents alone) and damage was proven to have resulted in the initial accident. Oh, and the field repair was oddly enough never an issue, go figure :confused:

I'd still like to know what would happen in a more imminent life threatening situation where you knowingly damage your vehicle in order to protect yourself. I really do hope the "reasonable person" test would see the claim approved.
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I have read case-studies (although none yet locally, but I guess overseas one's could rule precedence) where an insurance refused a claim on damages during a home-invasion as the owner fled the house by crashing the car through the closed garage door. On appeal the insurance was forced to pay for all damages. I have read quite a lot of local case law and OSTI has ruled against many of the local insurers on appeal (pointing fingers at two large insurers who seem to frequently get overruled by OSTI).
 
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