In a complaint that was submitted to our office, the complainant had submitted a claim to the insurer, also referred to as the participant, for damage to a microwave unit caused by power surge which was rejected by the participant on the basis that the damage was caused by wear and tear.
The participant’s reason for rejecting the claim was supported by an assessment report compiled by its appointed assessor. The report noted that the microwave could still be powered on, and its electrical components were functioning. It concluded that the most probable cause of the microwave’s failure was general wear and tear and it referred to the shattered microwave door and the panel frame detaching from the main door, both of which were indicative of age and prolonged use.
The complainant’s policy with the participant was a perils-based policy, meaning it only covered damage caused by specific listed insured events, referred to as insured perils, as set out in the policy wording. Under this policy type, the insurer is liable if the claim is caused by an insured peril, subject to the policy exclusions, terms, and conditions.
When a participant repudiates a claim by relying on an exclusion, it must prove the operation of the exclusion by substantiating its position with reliable evidence. The participant provided photographic evidence and the assessment report for our consideration. Having considered the participant’s findings, the onus then shifted to the complainant to demonstrate, on a balance of probabilities, that the damage fell within the scope of the policy by rebutting the evidence of the participant. The complainant therefore had to prove that the proximate cause of the damage was the peril of power surge and not gradually operating causes, such as wear and tear, which was an exclusion in the policy.
To do this, the complainant commissioned an independent assessment by the manufacturer of the microwave. The manufacturer found that the control module and transformer were defective, possibly due to a power surge.
On reviewing the evidence, being the reports submitted by both parties, it was noted that the complainant’s report did not address how the microwave could have been powered on if it had been damaged by a power surge. Additionally, the participant’s report confirmed that the microwave’s electrical components were in working order, which is inconsistent with the effects of a power surge. The complainant’s report attributed the damage to a power surge but lacked technical evidence to substantiate this finding. It was unclear how the manufacturer could have concluded that power surge was the cause of the damage without providing a detailed and reasoned analysis.
Furthermore, the photographic evidence presented by the participant indicated damage consistent with wear and tear, such as the detached panel frame. The complainant also acknowledged that the microwave was over 22 years old, making it highly probable that the damage was the result of prolonged use and aging.
Based on these findings, our office concluded that the complainant had failed to prove on a balance of probabilities that a power surge had damaged the microwave, and that the participant had proven on a balance of probabilities that the damage was due to wear and tear.
As such, the office was unable to uphold the complaint.
Nomvelo Kunene
Adjudicator – Non-life Insurance Division of NFO
