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Getting What You Pay For: How to Refute a Rejected Insurance Claim

- Featured article by LAWYERS-ONLINE.CO.ZA - October 2019

In 2018, a well-known insurer in South Africa refused to pay out a R2.4 million life insurance policy to the deceased’s widow. Social media rose up and the immense backlash forced the company to backtrack and pay out the sum as well as to announce a revision in their policy regarding payouts. In this case, social pressure changed the tide, but this is one case in many. How many claims are rejected on a daily basis due to loopholes and nonsensical technicalities? More than you would like to think.

It seems unfair that clients invest a fair amount into their insurances only to be denied the benefit promised to them at the end, and in many case these denials can be challenged. However, before signing an insurance document, contact a lawyer and have them go through the entire policy with you, highlighting key aspects that may be hidden in confusing legal terminology. Always use your access to legal representation to know what you are getting into.

A lawyer can be both a prevention and a cure for legal headaches.

But let’s say your claim has been rejected. What legal recourse do you have on your side? How can you refute this claim and make sure you receive what is legally owed to you?

  • As mentioned above before putting in a claim, make sure that you are legally allowed to do so by knowing your policies inside and out. Be ready to challenge a denial and run the claim past your lawyer if possible
  • Insure that your side is clean. This means having all your payments up to date, making sure your medical history is in order or that your car or home meets the criteria set out in the policy – you can’t go into battle when your side is dirty
  • You have to right to request an independent assessment of your claim – use that right afforded to you and get an objective opinion on the matter. This method is best for short term claims
  • The ombudsman is a vastly underused resource in South Africa. Available for both long and short-term insurance, the ombudsman is a free and independent service that can help investigate claims against your insurer
  • HOWEVER, always remember that the ombudsman is not a replacement for legal representation. If these methods above don’t yield the results you were hoping for, contact a lawyer today and seek legal recourse by taking your insurer to the court. The more this is done, the less people will miss out on payments due to them.

Of course, going to court isn’t free and you can expect to pay a consultation fee for your lawyer and the court fees, but if you are certain of your claim and your legal counsel feels that you will win, your fees may be recouped by the court in the final judgment.

Don’t allow loopholes to take your hard earned money away from you – you have more rights than you know and it is imperative to fight for these rights in a legal way. Talk to us about finding a lawyer to help you refute a refused claim today.

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