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Insurance company has reject my claim on the basis of fraud…

Customer Question
Insurance company has reject...

Insurance company has reject my claim on the basis of fraud and canceled my policy not sure how to dispute it

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MI

Lawyer's Assistant: What steps have you taken so far?

Raised an internal complaint to dispute the matter.

Lawyer's Assistant: Anything else you want the lawyer to know before I connect you?

A few days after I withdrew the claim the investigation department use

Submitted: 3 months ago.Category: South Africa Law
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Customer reply replied 3 months ago
A few days after I withdrew my claim the investigation department made a decision to reject my claim and cancel my policy
Customer reply replied 3 months ago
Insurance company claims invoice for 1 of items is fraudulent even after I advised the item in question should be withdrawn as it was company supplied device and thus i was not the legal owner.
Answered in 7 hours by:
4/8/2018
Lawyer: CaseLaw, Attorney replied 3 months ago
CaseLaw
CaseLaw, Attorney
Category: South Africa Law
Satisfied Customers: 1,706
Experience: BCom; LLB; Masters in Law
Verified

Hi there and thank you for your question,

I am a practicing attorney based in South Africa and I will try to assist you with your legal question but please feel free to ask as many follow up questions in order to clarify your initial question. If you have a new question, you must please open a new thread.

The answer is going to (unfortunately) lie in your policy. One of the clauses therein should deal with disputes, and there will be a process which is set out which deals with lodging a dispute.

But, I must tell you that you will need a valid reason for thinking that you can dispute their decision.

I must also say that in my opinion the insurance company is within its rights to reject a claim, and even cancel a policy, where there has been an attempt to commit fraud. A perfect example is (unfortunately) exactly what you've set out above.

Claiming for a device that you don't own under your personal insurance policy (even though you withdraw the claim) constitutes attempted fraud. That would provide them with grounds to terminate the policy.

I'm not too sure what argument you would have to prove that you didn't intend to do that.

If my answer hasn't provided you with enough clarity regarding your initial question, please send me a REPLY with follow up questions so that I can continue to assist you in this same thread for as long as you need. Let me know if you need more advice - don't just rate my answer as "bad".

If my are HAPPY with my answer then please click one of the STAR ratings or the SMILEY FACES to rate my answer!

Good luck and best regards,

CaseLaw

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Customer reply replied 2 months ago
Hi CaseLawThanks for the response and sorry with the delay in responding again.I've requested an Internal Despute Review and it has conculded that the initial outcome still stands and policy has now been cancelled on the basis of the claim been rejected on the basis of fraud.Just to clarify a few things.When I made the claim initally it did not occur to me that item I claiming for was not technically mine. The Item was purchased by me for work through company expense (IE: Work Credit Card) While it may be difficult to believe it was not apparent to me at the time that I was not the real owner and even after leaving my previous employer I held onto the device not deliberately for any gain but because nobody requested me to hand it back and It just never occured to me. If previous company called me up tomorrow and said: Hey please give us back the Laptop/Tablet I would now effectively owe them a new tablet.
That said as soon as it became apparent to me that ownership of the device was not mine - I had advised the investigator investigating the claim that the claim for the device is not valid and thus should be withdrawn.The document offered at the time of claim was not a valid invoice for which the basis of fraud is built upon. At the time of submission I thought it was valid - as it described the device and time frame from which I first acquired it. I had no other source of ownership : IE: Photos, other than the Pen Set/stylus for the device.Prior to the insurance firm making a decision I requested the entire claim be withdrawn. A few days after I received the rejection and policy cancellation.My Issue is It was never my intent to deceive or de-fraud the insurance although evidence may suggest otherwise I hold true to the fact that my actions were based on what I thought was true the entire time.The issue I now face is "Duty of Disclosure" to any new Insurance Company which when asked - Have you ever had an insurance policy cancelled other than non-payment. I'll have to answer yes and worse yet - disclose why. No Insurance company will be willing to cover someone previously engaged in fraud.If the Insurance Company did accept my claim intially and I stumbled on the same conclusion regarding ownership - I would be liable to return any replacement or payback any payout made.Do I have hope in fighting this or am I been naive - My Next step is lodging a dispute with ombudsmanThanks and regards
Lawyer: CaseLaw, Attorney replied 2 months ago

I would most certainly lodge a dispute with the ombudsman! Definitely. Essentially it would be on the basis that there was no intention to defraud. You'll need to set out the timeline of events as clearly as possible to show that you actually advised the insurance company of the mistake.

Regarding your new policy - you'll need to say "yes", but then you should explain that you are disputing the previous cancellation with the ombudsman, and you should send a letter explaining the background!

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