Question posted in the Insurance Law category relating to Gauteng
Question value: R 300.00
I hope and trust you are doing well.
I have lodged an complaint with the Ombudsman in regard to partial rejection of insurance claim from the insurance company. As I am aware that Ombudsman can take incredibly long I am seeking personal legal advice and assistance. I have already been without my car for two months and very dependent on my car. I cannot afford to wait other 3 months to a year as I have been advised the Ombudsman can take to help resolve the problem.
Herewith please find the following info.
I was unfortunate to be in a car accident on 05 June 2017. The claim was lodged with the insurance company on 06 June 2017. All requirements from the insurance company claim department were handled swiftly from my side and I tried to assist wherever possible to speed up the process. After delaying the initial estimate date I would have received my car back by two weeks, the vehicle was released on Thursday 24 August 2017 by the Panelbeaters. On the release of the car to my husband the Panelbeaters advised that the cars motor seems to have taken a knock.
I contacted the insurance company on Friday, 25 August 2017 advising them that there was something is wrong with my car. Late Friday afternoon my car broke down and had to be towed. The consultant had my car towed to Hyundai on Saturday morning, where in turn it was returned to the Panelbeaters.
The Panelbeaters took parts of the vehicle’s motor apart and took photo’s which they sent to the assessor for assessment.
The assessor phoned me on Thursday, 31 August 2017 to advise that they will not be covering the damage to the motor of the car as they found sluggish oil in parts of the motor which they feel blocked the oil flow and caused the damage to the car. I have requested an official written report from the insurance company's consultants that were working with my claim, to date I am still awaiting the requested report.
I feel that the rejection of the claim unjust as there were no issues with my car prior to the accident.
This year saw the anniversary of seven years with my employer. I took ownership of the car in June 2017 as part of my employment contract was that the car that I have been driving for the past five years becomes mine after a stipulated time period. In order to have the cars ownership change and licence renewal done the car had to go through road worthy first. I took the car to A+ Testing station where they initially rejected the road worthiness test due a spot light not working, rear tyres being worn and the wheel alignment. All faults were corrected and the car was taken back to the testing station. The car passed its roadworthy and documents of same was sent to the insurance company.
The car was inspected and passed roadworthy less than a month prior to the accident. Surely this constitutes as evidence that the vehicle was indeed in a good working condition prior to the accident.
In light of the above I requested that further investigation into the cause of the incident be made by the insurance company as there was nothing wrong with the car prior to the accident. The request was denied.
DOTSURE CLAIM DENIED:
The assessor advised that the claim was denied due to old oil built up in the cars sump as well as the oil filtering system. The assessor advised that the company felt the reason for the motor to seize was not accident related and will thus not be covering the engine.
REASON FOR DISPUTE OF REJECTION OF CLAIM:
Prior to the accident on 05 June 2017 there was nothing wrong with my car. The car was in good working order and it was in daily use.
As the car is no longer under Hyundai’s warranty and the fact that I only took ownership of the vehicle in June 2017, I have no record of the previous service the car went for as requested by the assessor. Only documentary proof I have of the state of the vehicle is the road worthy it had to pass before the change of ownership could be done in June 2017.
When the car was released to us by the Panelbeaters they advised that there was a knock to the motor and added that they were Panelbeaters and not mechanics and is not allowed to touch the motor of the car.
I advised the claim consultant on what they advised my husband, yet the car was still returned to the Panelbeaters after the breakdown.
Frontal collisions often result in damage to mechanical components. The cars cradle needed to be replaced after the accident. As the cradle holds everything in the car in place such as the engine and transmission including the lower control arms, torsion bar, end links, struts and steering gear are attached to the sub frame. This should have been an indication that the engine might have sustained further damage that are unseen to the eye due to the knock it took.
Both the radiator and radiator bottle needed replacement after the accident. This is an indication that further damage to the motor is highly possible. All engine car parts are closely packed, so when the engine’s temperature increases, other components around the motor including electrical wiring, fuel pump and other sensors could have been damaged.
After the car broke down on 25 August 2017 I further established:
The insurance company neglected to check the cars motor after the accident. No diagnostic tests were done to determine if any components on the engine got damaged that were not clear for the eye to see. When the Panelbeater took the car for alignment the first time after the repairs to the car was done the engine light came on. They checked the oil. Less than a pint was missing, yet they filled up the car with oil and the light went off. After the car was returned to the Panelbeater after it broke down (the motor seized) the complete motor and other components of the car was once again not checked. The Panelbeaters only took certain parts apart which spesifically was the sump and oil filtering system. A crucial part of the vehicles repairs were overlooked during the repair process. An overall check-up of your vehicle. A full work up could have caught whatever caused the engine to seize and could have prevented further damage to the car.From the time we collected my vehicle from the Panelbeaters (24 August 2017) to when the cars engine seized (25 August 2017) neither the car’s engine light nor oil gage came on as warning that the engine was not getting any oil. I had no issues with my car prior to the accident. I am thus not convinced with the findings of the assessor. There are several possibilities as to why the cars motor seized, without a detailed check on all parts of the car one cannot come to the conclusion that was given by the Assessor. The problem now lies that even further damage has now been made to the motor and pinpointing the origin could be challenging.
Please be so kind and look into this matter of urgency as I have been struggling for over two months now without my car.
Looking forward to your early reply.Yours faithfully,
Answer to the Question
Hi there and thank you for your question,
After having read your story I must tell you that you were correct to refer the dispute to the ombudsman for adjudication. There is clearly a dispute between yourself and the insurance company regarding the engine and the damage the engine sustained in the accident, and if the insurance company won't admit your claim, the ombudsman will be able to assist. That is definitely the best course of action. Not only is it free, but it is quite quick and will result in your car being repaired - if the ombudsman finds in your favour.
The only other thing that you can do is to issue a summons against the person who caused the accident to sue them for the damages sustained to the car. You'd need to get the insurance company to give you permission to do this, since in your insurance policy you would have ceded any claim that you would have to your insurance company.
One thing to check is whether the car actually had oil in it on 24 August 2017. For the engine to cease within 1 day (to me) suggests that when the panelbeater checked the engine they might have forgotten to put oil back in! That means that your car would have overheated and ceased up BADLY within a day.
What you should definitely do is to request your employer to provide you with copies of the service manual or invoices or whatever so that you can prove when your car was serviced. This is quite important!
Unfortunately with the ombudsman you need to wait for his decision. That means that you will be without a car until the whole story is resolved.
Essentially you were asking whether the ombudsman was the best route, and my answer is yes. You have started down the right path and you need to follow through with that.
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Information provided by client
Thank you for your reply.
1. I cannot sue the other party involved in the accident. I swerved out for a pedestrian and hit a truck head on. (Car smashed - but pedestrian lives)
2. The last service history recorded was end 2015 and no info on kilo's
3. I have been advised that the ombudsman takes between 3 months to a year to revert back on findings. This is a very long time.
What I actually wanted to know is if there is any other means that I can pursue this case?
Something that might speed up the process or get the insurance to investigate the matter further. Would a letter from an attorney maybe help? An if, what type of letter should it be ie what should it say?
Answer to the Question
Hi there and sorry for the delay,
Yes, you can sue the other party involved in the accident if that party contributed or was the cause of the accident and the damage to your motor vehicle.
If the last service was 2015 that's a little bit of an issue, especially since the oil might very well be thick and gunky by then and could actually cause engine damage!
The fact that the ombud takes 3 months to come back is a pain, but unfortunately that's just part of the system!
Q: What I actually wanted to know is if there is any other means that I can pursue this case? --> You could issue a summons against your insurance company in the Magistrates Court. That might kick them into gear to investigate and settle with you, rather than fight a summons in court!
A letter might assist, but I'm sure that they get dozens of lawyer letters each month. You ideally need a summons!