NFO TIPS TO PROTECT YOURSELF AGAINST NON-LIFE INSURANCE FRAUD

1. Ensure that you know what the security requirements are for your home and motor vehicle and ensure that they are implemented as soon as possible.
2. Always remember to inform your insurer as soon as possible of any changes to your policy, such as when you sell or buy a motor vehicle.
3. Know the “average clause“ in your policy. Ensure that your household contents and your home are insured for the correct replacement values. In the event of your being under–insured, your insurer may apply what is called “average”, as contained in the policy wording, in calculating any settlement on your claim. This may result in a significantly reduced claims pay-out.
4. Security requirements for theft and hijack claims may be contained in your motor vehicle insurance policy. Ensure that you comply with the requirements in order to have cover for such a claim. An insurer may reject your claim in the event of non-compliance. If a tracking device is required, it must be in a working condition at all times, and it is the policyholder’s responsibility to ensure this.
5. Read the policy documents! This includes the policy wording and the schedule. This will help you understand what claims the insurer will and will not settle and assist in ensuring that you have a valid claim. If something doesn’t make sense, ask your broker or your insurer directly to clarify.
6. Know exactly what your policy does and does not cover. If anything doesn’t make sense, ask for clarity.
7. If an insured is unhappy with the findings of a report obtained by the insurer and wants to challenge the findings of the report, he/she can obtain his/her own report to assist in proving their claim.
8. Always ensure that correct information is provided during the sales call as this affects whether the insurer accepts the risk and on what terms and conditions.
9. It is important to ensure that information given in the sales call is accurate and, if you do not understand a request, seek clarity. A policy is underwritten based on the facts submitted by the insured and may affect the validity of a future claim.
10. It is essential for all insured properties to be well maintained as insurers do not cover damage caused by wear and tear and a lack of maintenance.
11. Your policy contains strict time limitations for the reporting of claims and potential claims. Familiarise yourself with the policy conditions for the reporting of claims. It is best to contact your broker/insurer as soon as possible after an incident to notify them.
12. Make sure that your property is insured for the correct value. Even though the insurer may increase premiums from time to time to accommodate inflation, most policies stipulate that it remains the policyholder’s responsibility to ensure that all the items on the policy are insured for their correct replacement value. 
13. Winter is an opportune time to attend to roof maintenance.  Regardless of whether a storm took place, damage to buildings arising out a lack of maintenance is not covered in terms of a buildings/homeowner’s policy.
14. Having the latest cell phone is cool but it’s not cool when your insurer rejects your claim as your old phone is still covered and you did not place your new phone on cover. Check your policy regularly and update it, if necessary.
15. Know your policy: Understand the cover, exclusions, and conditions of your policy as this will assist you in identifying whether a claim rejection by your insurer is valid or if there is potential to dispute the rejection.
16. Document everything: keep correspondence, record specific dates and times, keep invoices and photographs as this would be helpful in substantiating any disputes of fact.
17. Stay professional: Maintain a professional and courteous demeanour in all your communication with your insurer. This can help facilitate a smoother resolution with the insurer and ease any frustration.
18. Stay Informed: This is easier said than done, but keeping up-to-date with changes in laws, regulations, and consumer rights can be beneficial when handling any issues/disputes that may arise.
19. Make sure that your policy schedule always reflects the correct replacement value of your insured items. Review your policy schedule each year and amend the replacement values if necessary. Remember, if an insurer agrees to settle a claim, you may not be paid the amount that you paid for the item, but rather the cost of replacing the item at the time of the loss/damage. So, if you bought a phone in 2022 for R10,000.00, and insured it for this amount, but it only costs R8,000.00 in 2024, the insurer will only settle the claim for R8,000.00 because this is the amount that it costs to replace the phone in 2024.
20. Don’t skip out on the regular maintenance of your property, especially roofs and waterproofing. This is especially important to prevent storm damage to your property. It may also save you from damage to the interior of your property and any potential rejection of a claim by your insurer.
21. Always provide true and complete information regarding yourself (insurance history, financial status, address etc), the risk insured or be to be insured, and any persons that may potentially be covered by the policy, in any capacity. This includes ensuring that you notify the insurer of any change pertaining to the details initially provided to the insurer at the inception of the policy.
22. In the event of a claim, ensure that you appoint your own service provider or assessor and submit your own service provider’s/assessor’s report to the insurer. Remember that you bear the onus/duty of proving that your claim is valid in terms of the cover provided.
23. Cell phone upgrade – be aware that when upgrading a cell phone, insurance does not automatically transfer from the old cell phone to the new one. The consumer must specify to the insurer that they want cover for the new cell phone.
24. Cell phone numbers – a typical requirement in cell phone insurance is that the consumer is required to use the device in conjunction with the cell phone number noted on the insurance policy. Should the consumer wish to use a different number, the insurer must be notified of the new number in order for the consumer to enjoy cover should a loss arise.
25. Most policies require consumers to comply with the law and the policy terms and conditions. Failure to do so may result in unpaid claims. It is important to make accurate disclosures and to provide true and complete information to your insurer at all times.
26. Make sure that you are not under insured, especially when it comes to your household contents. Take an inventory of the items you wish to insure and compare it with the insured value noted on your coversheet. Adjust your insured value as needed.
27. Always read through your updated policy documentation. Often, insurers make changes to your cover on renewal. Be on the lookout for, amongst other things, changes to your premium as well as your excess structure and excess amounts.
28. When comparing insurers, the price of the premium should not be the only consideration. A lower premium may seem attractive however the extent of cover can be limited. Consumers must therefore understand the cover they are being offered. Ideally, one wants to look for an insurer that offers a competitive rate in addition to a comprehensive policy that is not subject to a wide range of exclusions.
29. With climate-related perils becoming a common occurrence, consumers are urged to ensure that their properties are adequately maintained and can withstand normal weather-related damage. Given the country’s exposure to natural catastrophes, consumers have a responsibility to take preventative measures to minimise their exposure to damage and loss, for example, clearing gutters, securing nails and loose tiles, waterproofing the roof, etc.
30. Be concise in the details of your complaint/application for assistance to our office – we often find that consumers complain about a several issues, some of which have already been resolved by the insurer. This unnecessarily prolongs the complaint’s handling process so ensure that you raise issues that are still in dispute and unresolved.
31. When submitting a complaint to our office, ensure that it is accompanied by all the relevant documentation; this will assist in expediting the complaints handling process.
32. Know the coverage period: you must know for how long your warranty runs and ensure that you claim within this time frame.
33. Report promptly: contact your insurer immediately after noticing any problem as delays in reporting may impact on the result of your claim.Complete the claim form: to avoid unnecessary delays fill in the claim form properly and provide all information required.
34. Photographs and videos: take pictures or videos which assist in seeing the damage or defect clearly.
35. Know your rights: Seek assistance: you can approach the NFO for free assistance in the event that your claim is rejected.
36. Understand the pay-out process: familiarise yourself with how payouts are calculated and also the factors that affect their valuation.
37. Insurance broker: if you want guidance on understanding the policy or on how to navigate a claim, you may want to consult an insurance broker for professional advice.
38. The excess amount is always payable by the insured, regardless of who was at fault, such as in a motor vehicle accident claim, the excess is payable regardless of who caused the accident.
39. Remember, premiums are paid in advance. If the premium was not received for a specific month, then you are not covered for that month. To enjoy cover, always ensure that your premiums are successfully collected by the insurer.
40. The consumer must pay the premium every month in order to enjoy continuous cover. If the consumer does not pay the first premium on the inception of the policy, the policy will lapse and there is no 15 days grace period to the pay the first premium.
41. Consumers are advised not to put a stop payment on their premium payment because, if they do, the insurer will lapse the policy without giving the consumer a grace period.
42. There are instances where an insured is reluctant to provide an insurer with certain information as the insured argues that it infringes on their privacy rights as well as the Protection of Personal Information Act. It Is important to point out to the insuring public that an insured has a duty in terms of the policy to assist the insurer with any information that the insurer has reasonably requested to be able to validate a claim or risk. The information requested must however be reasonable and material to the claim or risk.
43. Hijacking of motor vehicles in South Africa is widespread. Some insurance policies require motorists to install two fully functional tracking devices as a safety precaution, especially on certain makes of vehicles that are targeted. If hijack cover is conditional on two devices being installed and kept in full working order, then it is the insured’s responsibility to abide by this condition in order to enjoy hijack cover. Often these devices assist in recovering vehicles and avoiding a total loss of vehicles.
44. Make sure that the contact information that you give to the insurer at the start of the policy is correct and current. It is also essential to update the insurer on any change in information such as your contact information. Do not ignore any correspondence from your insurer.
45. Do you have GAP medical cover in place to cover you in the event of a shortfall following a medical aid claim settlement? GAP medical cover can provide you with cover in the event of a shortfall.