Insurance companies.................who like to decline claims

flatfourfan

I've been dealing with one of the big ones who do my home owners insurance on my bond. 2 years ago, I contact them complaining about a waste water pipe that's constantly getting blocked. After doing an inspection, they decided that 25 meters of pipe must be replaced, I pay my R1500 excess and it gets sorted. Cool...............or so I thought. I notice that after winter the drain would still get block on occasion. So I call the insurance company again and say that things are still not kosher. To which I get the following reply.

Dear Mr..... Sorry to inform you of this matter, but we do no longer cover repairs to sub terrain an pipes as of feb 2011.......bear in mind I call in March.

So I decide.............screw you lot. I bitch that this should of been repaired with the first loads of pipes. The work in question was a 4m piece from the last inspection eye to the house. So they send someone out to have a look with the all seeing eye (lol) and the plumber says that man this should of been picked up with the first inspection as the earthenware pipes are buckled and very damaged and it's not recent damage. I'm thinking cool.............this is going to get sorted.

The assessor comes out, doesn't open up any holes, walks around the property while chatting to someone on the phone and then tells me that he'll contact the office and they'll get back to me.

2 days later..........Dear MR ......................We confirm having advised you on 13/04/2011 that we have rejected the claim.

I was thinking, bugger, now I have to dig up all of this and do the work myself. Then it sinks in, how the hell can the assessor reject the claim based on walking around my property............I go back to the insurance company in question and say, screw you, I want to see the assessors report!!!!! They ignore me for about a month and give me the royal run-around, so I go to hello peter. I have someone contact me the next day, they'll look into it. They then call me back last week and say that they'll replace the work based on the old claim and that I have nothing extra to pay.

This is what I learnt from this whole issue:

1) Always check the work done has been done properly, if you have any issues, report it immediately.
2) Insurance companies are actually supposed to do a property check before giving you home owners insurance, 99% of them don't.
3) The report from the plumber and the assessor is actually supposed to be more or less the same.
4) Assessors are there to save insurance companies money and therefore try and get out as cheap as possible.
5) Most of the people out there don't demand to see reports if they have been declined. It's your right to see it.

Cost for me to fix this out of my pocket..........R9000/ R14 000..............

I used to have this insurance company do my short term insurance and they skimped me on R250-00 for a headlight, so once it was fixed after much bitching, I left.....

[deleted]

4) Assessors are there to save insurance companies money and therefore try and get out as cheap as possible.

Sadly, that's something I realised when my insurance company assessed the damage to my car after someone else crashed in to me. It was much lower than any of the panel beaters I got quotes from and the other person's insurance company paid out according to my insurance company's assessment, not the panel beaters'. It's like they're collectively creating an alternate universe.

flatfourfan

Viccy wrote
4) Assessors are there to save insurance companies money and therefore try and get out as cheap as possible.
Sadly, that's something I realised when my insurance company assessed the damage to my car after someone else crashed in to me. It was much lower than any of the panel beaters I got quotes from and the other person's insurance company paid out according to my insurance company's assessment, not the panel beaters'. It's like they're collectively creating an alternate universe.

You know that you can reject that claim though? I've been involved in the trade for about 20 years and have a lot of contacts, when it's time to get quotes for car damage, i go straight to the guys who the dealers use as that will be the ceiling of the repairs and will pretty much be covered by everyone else. Also request that they use the data system to log repairs. On all cars there is a database of all cars in SA as well as when a panel is to repaired, how much time is need to do each repair as well as clips, screws etc, that way they get the claim 100%.

I rejected a claim on my wifes car because it was out by R200 and I said that there was no ways that I was paying R200 out of my own pocket when it wasn't my fault. Insurance company gave in.

My other advice is to work through a broker..........they are cheaper than going through the big companies and if you have hassles it's a brokers job to look into it.

DonovanB

Dude Please name these clowns so we can avoid them.

I've been with Outsurance for a while now, had to claim twice and both times my car was sorted with no questions asked.

After the last claim (Oct '10) they increased my insurance by 50%. I was devastated and got quotes from others who were lower, when I called to cancel they dropped the rate, although not less than the others, but I decided to stay because of the service. it is really that good.

[deleted]

Thanks for the tip fff, I was wondering whether to go the broker route.

flatfourfan

Donovan Banks wrote Dude Please name these clowns so we can avoid them.

I've been with Outsurance for a while now, had to claim twice and both times my car was sorted with no questions asked.

After the last claim (Oct '10) they increased my insurance by 50%. I was devastated and got quotes from others who were lower, when I called to cancel they dropped the rate, although not less than the others, but I decided to stay because of the service. it is really that good.

It was Outsurance...........I was paying R1800 for cover on the house of R540 000 (contents etc), 2 Honda ballades and they wouldn't insure my porsche. I dumped them and went to a broker who underwrites from Hollard and got the house, my Bakkie, my wifes Honda Civic and the porsche done for 3rd party for R1200.00, car rental included where ith outsurance it was R200 extra each month.

One thing to remember is that your insurance premiums should never really go up if you dont claim. Have you insurance company revalue your vehicles once a year and have the amounts on the value re-assesed as they value drops. My wife's honda went from R85 000 to R79 000 to R76 000 and normally you'd still be paying for 85k value, where actual pay out is only 76k. Working through a broker (a good one) is a bonus here, because they follow up with you each year.

My broker has been doing mine and about 10 friends short term insurance for the last 7 years with zero issues. I have claimed a few times. (lightning strike and 2 accidents of other people hitting us).

Norman86

Insurance, Medical aid, Banks and Lawyers are the bane of the earth... >☹

singemonkey

Norman86 wrote Insurance, Medical aid, Banks and Lawyers are the bane of the earth... >☹

Lawyers are the odd ones out there. They don't automatically have an incentive to screw you. That all depends on who they're working for. The other three? Screwing people is how they earn their loot. No exceptions.

Ray

Norman86 wrote Insurance, Medical aid, Banks and Lawyers are the bane of the earth... >☹

Some lawyers. But you left out the goverment, SANRAL, capitalists, communists and lots of other humans. Oh yes, and the pigs. But mostly insurance companies and the pigs.

Wizard

Switching to a broker was a brilliant move for us.
Premiums dropped; with service speed and likelihood of claim going up.
They have the muscle to fight on your behalf.

StephenG

Norman86 wrote Insurance, Medical aid, Banks and Lawyers are the bane of the earth... >☹

actually its not the medical aid's - but rather the entire medical profession that is screwing you via your medical aid - its sex by proxy !

the medical aid is just passsing on the screwing in an attempt to get consumers to rise up against the medical profession, but unfortunately the comsumers anger is always misplaced against the medical aid.

Bob-Dubery

StephenG wrote
Norman86 wrote Insurance, Medical aid, Banks and Lawyers are the bane of the earth... >☹
actually its not the medical aid's - but rather the entire medical profession that is screwing you via your medical aid - its sex by proxy !

the medical aid is just passsing on the screwing in an attempt to get consumers to rise up against the medical profession, but unfortunately the comsumers anger is always misplaced against the medical aid.

A couple of years ago I did quite a bit of work with medical aids. It's more complex than you think.

Medical aids do tend to drive costs down - for their members and on things like charges for theatre time, days in a ward and so on.

They don't have to apply pressure over drugs because drug prices are now regulated by government - the price is fixed, you may not charge more, you may not discount. Full stop. They also monitor things like charges for gasses in the theatre, the number of times a saw blade gets used.

They keep very close tabs on dentistry (an area of abuse in the past) by keeping tabs of what was done to which tooth and when (it doesn't happen so much now, but a few years ago several dentists got asked why they had extracted the same tooth multiple times, or why they said they had extracted a tooth but the patient still had a full set).

I'm not saying that the medical aids are all saints, but they have uncovered several dodgy practices in the past and have confronted the service providers involved, calling in the lawyers, the authorities or (worst of all in some ways) the press if necessary. Of course their motivation is to keep their own costs down, but the effect is that they do exert pressure on service providers and often everybody benefits from that.

Riaan-Combrink

Ray wrote Some lawyers. But you left out the goverment, SANRAL, capitalists, communists and lots of other humans. Oh yes, and the pigs. But mostly insurance companies and the pigs.

Ouch, Ray! I'm a government lawyer - so that's a double whammy! ?

StephenG

X-rated Bob wrote A couple of years ago I did quite a bit of work with medical aids. It's more complex than you think.

Medical aids do tend to drive costs down - for their members and on things like charges for theatre time, days in a ward and so on.

I've a pretty good idea how complex it is in that there medicla aid wilderness..

agreed, that it is a large part of the medical aid trying to push their own toothpaste back into the tube...

and i think they have acknowledged that, but like you said, they are doing a lot more "good" in trying to get costs down..

and using its own members to do so as a last resort..

but, like i said, we are all still to quick to blame the medical aid for NOT paying a certain bill, when we should rather be complaining towards the health care provider for charging something stupid...

or, like the examples you use - totally abusing the system by removing the same tooth a number of times.

2 weeks ago or so, my medical aid was billed by a hospital for almost R1,500 for the 6 hours I spent waiting in their ward for NOTHING... i walked in at 12noon and walked out again at 6pm, without so much as a glass of water from them.. and they billed my M.A. for it... and i didn;t even get to see a nurse or a doctor.

Bob-Dubery

StephenG wrote but, like i said, we are all still to quick to blame the medical aid for NOT paying a certain bill, when we should rather be complaining towards the health care provider for charging something stupid...

Even that's not as simple as people think. If you got to St StephenGs for treatment and the doctor is Dr X-rated then St StephenGs have no control over what Dr X-rated charges for his services or what he dispenses. The private hospitals may not employ doctors to treat people (they may employ them in managerial roles). This is to prevent collusion. So knowing who to blame can be tricky. The hospital typically charges for the drugs because they were issued from hospital stock, but the doctor gives the instruction to administer a certain drug and the hospital can't refuse to do so. So you might think it's the hospital who is screwing you, but the doctor decides on treatment. *

Things are not straight forward in this industry and it's always advisable to check things out properly. A while back a certain medical aid threw a wobbly because male members were being billed for tampons.

Rip off? Taking chances? Sheer incompetence?

None of the above. Several doctors and paramedics had figured out that tampons were quick and convenient, not to mention keeping costs down, when they were treating traumatic cases, especially broken noses.

* you're saying "what if the hospital is crooked and is charging for stuff that the doctor never prescribed and I never got?". Good question. The medical aids get a lot of data that they can do number crunching with. They will know that, for example, an appendectomy on a male adult with no complications usually takes X days in hospital, Y mg of Drug Q and so on. If they get a case where it looks like something unusual has been charged they will audit that case. They will call for copies of prescriptions and so on and make sure that everything prescribed was given and everything charged for was prescribed. They typically audit a random sample of cases anyway.

Ray

Riaan C wrote
Ray wrote Some lawyers. But you left out the goverment, SANRAL, capitalists, communists and lots of other humans. Oh yes, and the pigs. But mostly insurance companies and the pigs.
Ouch, Ray! I'm a government lawyer - so that's a double whammy! ?

Ag sorry Riaan. One of my chess tjommas is also a government lawyer and he's a good oke. Although I watch him carefully when we play. I just think that in this society you cant really get surprized when an insurance company sharks you. It's what they are made to do. It's the system. It cant work if that doesnt work. So really the system is the swine. To say the medical profession screws you is also funny. They're supposed to. All you can do is fight tooth and nail to get screwed as little as possible. But there is no way you will retain your virginity. Dont complain. But mostly the pigs.

StephenG

Ray wrote But mostly the pigs.

i am not sure why you keep going on about the pigs....... there is no finer breakfast snack in the history of man kind, than a crackling piece of fresh fried pig..