The complainant submitted a claim for accidental damage to a Smeg kettle.
The insurer rejected the claim on the basis that the incident claimed for was not covered under the policy.
The policy on which the complainant relied for indemnification was a perils-based policy, in other words, the policy provided cover in the event that damage to an insured item resulted from a peril that was listed in the policy.
During the validation of the claim, the insurer appointed an assessor to assess the damage to the kettle. The assessor reported that the damage to the kettle was due to accidental damage. The assessor reported that the kettle lid and hinge were damaged and bent beyond repair and recommended that the kettle be replaced.
On receipt of the assessor’s report, the insurer concluded that the claim did not fall within the ambit of cover as the policy did not cover accidental damage to kettles.
The policy provisions relied on by the insurer to substantiate its decision to reject the claim stated as follows:
“Household Goods
- ACCIDENTAL DAMAGE TO TELEVISION SETS AND GLASS
We will indemnify You against accidental Loss in the Dwelling for:
4.1 any television set, video / DVD recorder or decoder (including portable aerial and/or satellite dish);
4.2 any glass or mirror glass that forms part of any article of furniture.”
and,
“13. SPECIFIC EXCLUSIONS
We will not be liable for:
13.9 accidental damage unless specifically covered.”
The complainant contested the insurer’s decision to reject the claim. The complainant contended that the policy provides cover for all household covered, therefore, accidental damage to the kettle should be covered.
After reviewing the submissions made and information provided by both the complainant and the insurer, and the relevant policy provisions, the NFO concluded that the insurer’s decision to reject the claim was justified.
Insurance policies are subject to terms and conditions, including exclusions, which are outlined in the policy documents. The onus lies with policyholders to familiarise themselves with the terms and conditions in order to better understand the cover provided.
Eunine Dlamini
Adjudicator – Non-life Insurance Division of NFO
