Many of us have experienced the rather annoying task of cleaning up after a geyser burst. This is something that makes us grab the yellow pages in a frantic search for any available plumber.
Should we do so or should we rather consult our insurer first? What if the insurer or the approved plumber is not available?
Let us for a moment discuss these questions and refer to decisions by the Ombudsman for Short Term Insurance.
What does the insurance policy stipulate?
In any question about insurance and the duties and obligations of either the policyholder or the insurer it is always best to revert to the policy. The policy will stipulate what to do in these instances and whether the insurer has specified specific approved plumbers to repair or replace the geyser.
There are good reasons why the insurer might only provide cover for services delivered by approved plumbers. These decisions are usually based on both quality control and pricing and should enable for the swift, convenient and reasonably priced delivery of quality service!
But what if such a plumber is not to be found or there is poor response from the insurer?
Here are two cases that appeared before the Ombudsman for Short Term Insurance.
Burst geyser: insured appointed his own plumber
The Insured, a Financial Planning Consultant got more than he bargained for on Boxing Day 2003. At about 22h30 his geyser burst — he turned off the geyser’s electricity as well as water supply. At approximately 08h30 on Saturday, 27th December 2003, he telephoned the emergency share call number of the Insurer and the message that he received after being transferred to the approved plumber’s number, was “the subscriber you have dialled is not available at present. Please try again later”.
The Insured continued to phone the sharecall number for the next hour, but he continued getting the same message. In desperation he then took his Yellow Pages Directory and found the number of The Drain Surgeon. He decided to use this company as it stated on its advert that it was an Insurance approved plumber. The Drain Surgeon fixed the problem quickly and professionally and the Insured then paid the plumber’s bill amounting to approximately R4,700. The Insured submitted his claim to the Insurer, which after taking the Excess of R500 into account paid a settlement in the region of R2,700, leaving a shortfall of R1,500.
The Ombudsman pointed out that the Insured through no fault of his own, was unable to speak to an approved plumber designated by the Insurer and that it had not provided for an alternative number or even a company name via the sharecall number. The Insurer conceded and made payment of the shortfall of R1,500.
[Source: The Ombudsman Newsletter : 03/04]
Repairs performed by a member of panel of service provider
At 15:45 one afternoon, a pipe burst under the floor or inside a wall of the insured’s property. He promptly called his plumber, who he had used for about 15 years. The plumber immediately responded, opened the tiles and some bricks and switched off the mains, returned the next day and finished the job.
When the insured lodged his claim the insurer rejected liability because the insured had not followed the correct procedure, i.e. to call the toll-free number which would have referred him to a panel of service providers. The insurer pointed out that it had written to about 300 000 clients advising them of the new arrangement, providing insured’s with the toll-free number and a paragraph drawing their attention to the necessity of calling the Claims Centre and that in the event of not doing so, the possibility existed for the claim to be rejected.
The Ombudsman pointed out to the insurer that the insured was very clear in his recollection that after he telephonically reported the loss to the insurer, he was at no stage asked to abort his instruction to his own plumber. The insurer accepted the proposal of the Ombudsman that they pay the amount, which they would have paid had a service provider nominated by the insurer carried out the repair.
[Source: The Ombudsman Newsletter : 04/03]
Conclusion and Advice
Insured Clients are often unaware of what to do in a roadside or household emergency. Policy documents are often out of sight and difficult to find. We would like to advise the following:
Take the time to refresh your knowledge of your insurance policy.
It is best to do so while there is no haste – don’t wait for an emergency before you search for answers!
Keep the number of your broker or the Call Centre of your Insurer safely stored away on your phone for easy access.
Follow the advice and directives from your insurer.
Ask questions to clarify any uncertainty and write down the time of call – these calls are recorded and could be accessed later in the unfortunate event of a dispute.