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Background
Drawing on 58 years of experience in the insurance industry RC has a proud history and tradition of always striving to offer Policy Holders the best advice and outcomes for their claim disputes. We walk our talk and bring our full team of experts to deliver on our promise.
Millions of South Africans are frustrated by jargon, technical rejections, and repudiation, leaving much needed cash unpaid and not knowing who to turn to or what to do. RC was established to help you ensure that you are rewarded for what you are legally entitled.
Don’t give up! We are here to help.
Repudiated Claims (RC) was formally launched in early 2008 as a result of the repudiation of two substantial claims. The insurance companies involved in said claims were hoping that the claims would somehow ‘disappear’. The one thing aforementioned claims had in common was that, once the insured party died, there could be no claim for Comprehensive Disability (Disability and Impairment) or Comprehensive Critical Illness (also known as Trauma).
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Due to the fact that there is a waiting / survival period before a claim can be lodged, most doctors / clients / brokers / agents and administration personnel involved are not aware of the consequences of delaying this type of claim. The insurance company will often also attempt to convince the claimant that there is almost no possibility of succeeding with a Disability or Critical Illness claim once the insured person has died.
One would assume that, should a loved one, or client, die, the claimant would have the full support of the Insurers concerned – especially since the Insurers allegedly follow a process whereby they medically underwrite their clients before the claim stage. Sadly, the reality is that many of these claims never get paid out as the Insurance Company effectively shuts the claimant out, often bombarding him or her with questions and technical jargon relating to policies and procedures, which – especially in a time of grief – could render one ineffective and overwhelmed.
It is crucial that the claimant or broker / agent be aware of the claims process and of any potential obstacles, and what procedure to follow in the event of a repudiated claim, or the ombudsman will have very little chance of a successful claim. RC (Repudiated Claims) can be of assistance in dealing with claims promptly.
Our legal associates specialise in repudiated claims, although from past experience, we are often able to bypass the legal process.
Solutions
Do your homework to prevent repudiation down the line
According to market analysis, as many as 30% of reported claims are rejected by well known, locally registered companies.
As one insured commented : “Had I known I had a 50-50 chance of my claim being repudiated by a particular insurer, I would not have paid the premiums all those years … only to be let down at the very moment it counted!”
But how do we know which insurer we can rely on?
This is the crux of the matter. Despite the updated insurance legislation, policyholder protection rules, and now the FAIS (Financial Advisory and Intermediary Services) Act, lack of disclosure will remain the biggest obstacle for many a consumer.
Johan van Wyk of Repudiated Claims says: “The new laws won’t help. There are not enough controls and still not enough disclosure.”
Johan gives us a list of what to look out for, and questions you should be asking your underwriting manager
- How many claims are repudiated by the insurance company each year, and why? Without this information, a consumer is unable to make an informed choice as to where to place his or her business. Unfortunately current legislation does not allow for this kind of transparency, and until it does, people will remain in the dark.
- Cost should not be your main consideration. Many clients have little to go on but price, yet the cheapest is not always the best. Clients who ignore a broker’s recommendation and insist on the cheapest cover, should be asked for a letter confirming their intentions, and then in turn be given a cautionary statement by the broker.
- Know the insurance company’s financial position. A well-funded, properly run business will have the wherewithal to honour claims. The company’s solvency margin is a useful guide but is insufficient in itself. Ask about the company’s reserving philosophy, how it is structured, does it pay high dividends, or does it prefer to maintain share value?
- Get information about the insurance broker – in terms of business continuity, market reputation and the quality of his or her general administration and claims services.
Once a client signs up we will assist with his whole portfolio of claims
Repudiated Claims is an independent operation offering services directly to clients, insurance companies and insurance brokers or agents. Some of the bigger brokers prefer to outsource their more complex claims, since it is often more cost effective.
In turn, Repudiated Claims outsource to specialist associates – including legal and forensics – which investigate the validity of claims before commencement.
Repudiated Claims also conducts independent risk surveys on behalf of both local and overseas companies.
Johan van Wyk says: “We often find that the smaller broker, while needing assistance in finalising a particular claim, prefers not to turn to the larger brokers for survey work because they end up losing the account”.