Trusted Outcomes
With over R100 Million secured for clients so far, Repudiation SA stands as your unwavering ally in taking on the challenge against insurance companies or brokers on your behalf when your claim has been rejected.
How can we help?
Click on any number below to view our process
Claim Arises
The date your claim arises is called the “date of loss” or “date of illness/injury” in the insurance world.
This date is important because you have a specific time frame to notify your insurer.
It’s recommended you let your insurer know about the pending claim as soon as possible, even if it takes time to gather all the information. Preferably, do this in writing by email.
Claim Submission
You would need to complete claim forms and submit any supporting documents required as specified by your insurer. Once submitted, the insurer will register your claim and provide a claim number.
Your claim will then be reviewed and potentially assessed. An investigator may be appointed in this process. Once all steps are complete, a report with a recommendation will be submitted to the technician/underwriter.
If the recommendation isn’t in your favour, the insurer will notify you of the claim rejection in writing.
Claim Rejection
Should your claim be rejected, the insurer’s communication will include the following:
- Formal Notification of Rejection
- The Reasons for Rejections
- The process you can follow if you are dissatisfied with the outcome.
Claim Mediation - Where Expertise Meets Fairness
In the realm of conflict and disputes, sometimes, the voice of reason can make all the difference. Our team of seasoned legal and insurance experts step in to enhance the strength and credibility of your claim against the Insurer.
Through skilled negotiation, we strive to achieve fair, just and equitable resolutions, sparing you the frustration of prolonged courtroom battles. In this process, an impartial Third Party will hear both sides of the dispute and offer advice, suggestions and guidance so as to allow the parties to reach a mutual agreement, if possible.
Claims Arbitration - Elevating Resolution to a Higher Standard
When mediation reaches an impasse, we escalate the proceedings to a more structured approach: arbitration.
Here, under the guidance of an impartial adjudicator, both parties present their arguments, and the adjudicator makes their final ruling on the matter. This ruling is binding on the parties, however, may be subsequently challenged or reviewed.
Leveraging our extensive expertise in both the legal and insurance industry, we lead this process to achieve a favourable outcome, fostering closure and reconciliation.
Litigation: Your Shield in the Legal Arena
As a last resort, we stand unwaveringly by your side, ready to champion your cause in the courtroom.
With a team of top-tier legal professionals, we navigate the complexities of litigation, tirelessly advocating for your rights until justice prevails. Rest assured; your case is in capable hands as we pursue a decisive resolution.
Depending on the complexity of the matter, this may take anything between 18 to 36 months, before final ruling on the matter.
How can we help?
Tell us about your claim.
Big insurance companies make their policies deliberately vague and confusing, to speed up their claims process. However, with our expertise, we will be able to find a way to dispute the rejection of your insurance claim.
If you believe your claim was wrongfully rejected, kindly fill in this form and one of our expert insurance claims consultants will get back to you as soon as possible.
If you believe your claim was wrongfully rejected, kindly fill in this form and one of our expert insurance claims consultants will get back to you as soon as possible.
Success stories
Life Insurance Claim Dispute
R23.5 million
Claim Value
+/- 4 months
Duration
Senior Advocate
Legal Representation
20 page
Legal letter
Our client faced a significant challenge when a large Insurer claimed their father’s life insurance policy had lapsed due to missed payments, despite the insurer previously accepting late premiums.
Repudiation SA intervened, drafting a comprehensive 20-page letter with the advice of a Senior Advocate, and successfully secured a full payout of 23.5 million Rand in just 4 months.
Property insurance claim
R500k - R1m
Claim Value
Full claim settled out of court
Settlement
Senior Advocate
Legal Representation
Unspecified
Resolution Timeframe
The client operated a successful sporting goods store, with stock values fluctuating between R500,000 to R1,000,000. Understanding the importance of protecting their assets, they ensured regular updates to their insurance policy to reflect changes in stock value.
After suffering significant losses due to an unforeseen incident, the client filed a claim through their broker, expecting to leverage their diligently maintained insurance coverage. However, they encountered resistance from the insurer, who was reluctant to recognize the full extent of the claim.
Vehicle Insurance Claim Due to Alleged Road Unworthiness
High mileage, depreciation
Deductions Applied
Retail vs. market value
Valuation Types Contested
R200 000
Claim Value
Full value claim at market value adjusted for deductions
Outcome
A vehicle owner’s claim was fully repudiated due to alleged tire issues.
Repudiation SA successfully challenged this, demonstrating the vehicle’s proper servicing and tire condition.
Ultimately, they secured a full payout of R200 000 for the client, adjusted for mileage and depreciation.
Property Insurance Claim
Storm damage, alleged poor construction
Damage Causes
Direct communication with Insurer
Resolution Method
Durban North
Location
Full wall repair
Outcome
Homeowners in Durban North faced repudiation from their insurance company, citing poor workmanship for storm damage.
Repudiation SA countered this by providing expert reports and evidence, successfully convincing the insurer to fully repair the damaged wall without issuing summons.
Vehicle Damage Claim Involving a Golf GTI
Summons issued and defended
Legal Stages
Full payment and engine replacement
Outcome
Second-hand, prior repair
Vehicle Condition
1.5 years
Duration
The owner of a second-hand Golf GTI faced a repudiation claim after the vehicle suffered undercarriage damage.
The insurer alleged intentional damage.
Repudiation SA fought this claim in the Magistrates Court, eventually leading to a full payment and engine replacement before trial.
Ongoing Case: Personal Injury Claim
R75 million
Coverage Amount
Back injury with alleged non-disclosure
Claim Issue
Material non-disclosure
Insurance Stance
Doctor admitted error
Medical Report
The client in this case faces a challenging situation with a R75 million cover at stake.
The insurance company repudiated her claim for a back injury, citing material non-disclosure, despite a doctor admitting an error in the report.
Repudiation SA is actively working to resolve this complex matter, advocating for the client’s lack of knowledge regarding the non-disclosure.
Success stories
Property Insurance Claims
Storm damage, alleged poor construction
Damage Causes
Direct communication with Insurer
Resolution Method
Durban North
Location
Full wall repair
Outcome
Life Insurance Claim Dispute
R23.5 million
Claim Value
+/- 4 months
Duration
Senior Advocate
Legal Representation
20 page
Legal letter
Property insurance claim
R500k - R1m
Claim Value
Senior Advocate
Legal Representation
Full claim settled out of court
Settlement
Unspecified
Resolution Timeframe
Vehicle Insurance Claim Due to Alleged Road Unworthiness
High mileage, depreciation
Deductions Applied
Retail vs. market value
Valuation Types Contested
R200 000
Claim Value
Full value claim at market
Outcome
Let us be your voice.
Rejected insurance and medical aid claims don’t have to be a one-sided process.
Although insurance companies keep repudiation rates private, it is estimated that there are over R1,2 billion worth of rejected claims each year. Many of those claims could be won by an insurance claims expert.
Let us go to bat for you, and we’ll ensure the best possible outcome when your insurance refuses to pay out.
Resources
You have the right to inform yourself.
9 tips to avoid having your insurance claim rejected
Riana Wiese, a financial adviser at PSG Insure Meesterplan, says
Fais Ombud concerned about high rejection rate of homeowners’ insurance claims
The way homeowners’ insurance policies are sold and the high
Fais Ombud recovers R39m for consumers in one year
Compensation of R39.13 million was paid to consumers due to
9 tips to avoid having your insurance claim rejected
Riana Wiese, a financial adviser at PSG Insure Meesterplan, says
Fais Ombud concerned about high rejection rate of homeowners’ insurance claims
The way homeowners’ insurance policies are sold and the high
Fais Ombud recovers R39m for consumers in one year
Compensation of R39.13 million was paid to consumers due to
How your insurance claim could be rejected
Insurance provider Momentum recently grabbed headlines when it refused to
Loadshedding gives rise to Power Surge complaints
The existence of load shedding schedules means power surges are
Momentum Insurance lesson: Following the law is not enough
When Momentum declined to pay out Nathan Ganas’s life insurance
WHAT IS REPUDIATION OF CLAIM?
Repudiation in insurance claims refers to the rejection by insurers to pay a claim. The rejection is related to a specific reason such as non-adherence to a warranty or condition in your contract of insurance or non-disclosure. Essentially, repudiation occurs when one party refuses to honour a contract with another party.
WHEN TO SUBMIT A CLAIM?
Most insurance policies require the insured to report/submit an insurance claim within a certain number of days. Failure to adhere to these requirements may result in a rejection of a valid claim. It is crucial to understand and adhere to the requirements of the policy.
WHAT TO DO IF INSURANCE CLAIM IS REJECTED?
If an insurance claim is rejected by an insurer or if the claim amount awarded is lower than the expense being sought to be covered under the policy, the aggrieved policyholder is required to first file a complaint with the insurer concerned before approaching an ombudsman or seeking legal advice in the matter.
WHAT ARE THE MOST COMMON REASONS WHY CLAIMS GET REJECTED?
While the reasons for insurers rejecting claims vary from insurance policy to insurance policy and the types of cover, there are basic insurance terms and conditions that apply across the board:
- The duty to provide sufficient and accurate information;
- The duty to adhere to any warranties on the policy;
- The duty to keep up with premiums;
- The duty to submit a claim timeously and
- The duty to adhere to the correct claim procedure
Your failure to meet the aforementioned terms and conditions will no doubt lead to your claims being rejected.
WHAT DOCUMENTATION IS TYPICALLY REQUIRED WHEN SUBMITTING A CLAIM?
When submitting a claim, the claims consultant will guide you on what information and documentation is needed to process the claim, depending on the event which led to the claim. However, the typical requirements include:
- The original policy documents, claim forms and the policy number;
- You are to provide full details of the incident, this includes the date and time of the incident, names, addresses, telephone numbers, driver’s licence and licence plate numbers of all people involved;
- Damage reports, photographs, videos (if any), statements, proof of ownership, quotations;
- Certificates of death issued by home affairs, hospital certificates and records, comprehensive medical reports, and assessments.
WHY IS IT IMPORTANT TO DISCLOSE CRUCIAL AND RELEVANT INFORMATION TO THE INSURER?
If you have provided inaccurate information to your insurer or you have failed to disclose material information and facts at the inception of your policy, it may result in an unsuccessful claim later on. An insurer uses the information provided by the insured to determine the risk profile and the subsequent rate based on the profile as well as additional premiums, exclusions, or warranties of the policy. If the insurer discovers that inaccurate or incomplete information was provided about you, or anyone insured on your plan or that you have failed to disclose material information and facts they may reduce your claim or decline your claim entirely.
WHAT DO YOU NEED TO DO TO ENSURE THAT YOU ARE COVERED FOR YOUR CLAIM?
You need to have had cover at the time of the claim event. If you are without cover, it could be a result of not having paid your premiums on time, or your benefit having ended. When you miss a premium payment, a grace period may usually apply (depending on the terms of your policy), which can give you a bit more time to pay your premium before your cover lapses. It is imperative that you check when each benefit’s end date is, after which it will no longer provide cover.
UNDERSTANDING THE CONCEPT OF EXCLUSION
If you claim for something from your insurance that is indicated to be excluded in your policy documents, your claim will be declined, as an exclusion means that you do not have cover for that condition or event. An example is a medical exclusion on death, disability or dreaded disease benefits that were placed on your policy.
WHAT IS AN INSURABLE INTEREST AND WHO BEARS THE RESPONSIBILITY OF PROVING AN INSURABLE INTEREST EXISTS
When taking out an insurance, it is important for the insurance company to establish that you have an insurable interest in the property. In other words, you would have to provide sufficient evidence to show that you would stand to suffer a direct financial loss if there is a claim. An insurance company may not cover the property if you are not directly responsible for it. For example, if your house is damaged by a fire, the value of your house will be reduced, and whether you pay to rebuild the house or sell it at a reduced price, you will suffer a financial loss resulting from the fire. The insured bears the responsibility of proving that an insurable interest exists.
