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Medico wins in insurance claim dispute

By unknown | Nov 19, 2008 | COMMENTS [ 0 ]

The worries endured by a medical practitioner, Lucia Lekala, are now over.

The worries endured by a medical practitioner, Lucia Lekala, are now over.

Three weeks ago Consumer Line carried an article about insurance companies that try to find loopholes to avoid settling a claim.

Lekala was one of such insured people whose insurance company declined her claim on the basis that she had not disclosed a previous claim.

In January this year, when taking out a policy with Absa Brokers, she told the broker to check what information was needed from her previous insurer, Santam.

But the broker marked certain sections with a zero, meaning they were subject to verification.

The broker did not complete these sections after getting the claims history from Santam.

Seven months later, the doctor had an accident and her vehicle was written off.

When she lodged a claim it was rejected on the basis of non-disclosure.

Lekala said the broker did not ask her to explain the discrepancy before submitting the claim.

"The failure to obtain this information caused me a big loss."

Absa offered to pay only part of the R79778 damages after the Gauteng Consumer Affairs Office had intervened.

Lekala then asked Consumer Line to take up the matter.

Absa did not want to respond to Consumer Line. It said it preferred to deal with Consumer Affairs.

Absa brokers have now reconsidered their offer and agreed to settle Lekala's claim in full.

Absa noted that when Lekala signed the document in January, she should have taken care to fully understand its contents.

Lekala, who was grateful to both Consumer Affairs and Consumer Line, accepted their offer of R147818.

l Never sign any document that is not completed. In law, it is assumed that you have read all the contents of the contract before signing.


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