Friday, October 05, 2012

Rejection of insurance claims

Mr. Lee  send an email to ask me why I am speaking against AXA for their handling of the Ferrari claim and why I am supporting the renewal of the motor insurance for Mr. Tan Yaw Cher's car. He said that, as a consumer, he does not want to pay the claims caused by "reckless driving".

It is easy for people like Mr. Lee to hold this view, until they are placed in the shoes of Mr. Tan.  They will then know what it is like to be treated unfairly.

Let me first deal with the Ferrari accident. AXA said that they cover "accident" and do not cover "collision". I am amazed at this explanation. When two cars collide, it is a collision. The collision can be caused by "accident" which is covered or by deliberate intent, which is not covered. I checked AXA's policy and found that they do cover "collision" but they have the right to deny liability if the collision is caused by "willful intent" or "willful negligence".

I do not think that the Ferrari driver had the "willful intent" to cause the collision. It is not clear if the claim could be rejected due to "willful negligence". I did some research on what is "willful negligence" and found some reference about medical malpractice, but could not find any reference to its application on motor insurance.

There is a principle of contract law that if a provision in an insurance contract is unclear, the court will decide against the party that drafted the contract, as it has the duty to make the terms clear. This is called the principle of "contract of adhesion".

I will let the court decide on this matter.

Let me deal with Mr. Tan's case. NTUC Income said that the daughter was driving dangerously. I wondered how they arrive at that conclusion. There was no dispute that she was careless in driving through the red light. but was it just careless, negligence or recklessness?

I had once turn right against a red traffic light. At that time, the light showed green for driving straight but I did not notice the red arrow for turning right. Fortunately, the oncoming traffic stopped in time. While I was careless, I was not reckless.  It is quite easy to be confused with so many traffic lights - some of which are meant for pedestrians, especially when driving along an unfamiliar road or at night.

We have to wait for Mr. Tan or her daughter to reply to the accusation of "dangerous driving".

I am quite worried, on behalf of consumers, that some insurance companies appear to be trigger happy in rejecting claims, in spite of their contractual liability.








3 comments:

Tan Kin Lian said...

Someone asked me what I would have done, if I were running AXA.

There is unclarity about the application of the exclusion due to "wilful negligence".

Instead of rejecting the claim, and going to court to fight it, I would suggest mediation.

It would be fair for the insurance company to pay 50% of the insured value of the car, i.e. both parties share the loss.

I believe that the family of the Ferrari driver would be willing to accept a midway settlement.



yujuan said...

If buying insurance entails going through a minefield, makes one wonder why we buy it at all.
Why all insurers are so dishonest, ever trying to get themselves off the hook when claims are made.
Insurers and other FIs like Banks and Stock brokerages are really bedfellows, made for each other, ever playing on loopholes in wording terms to confuse and pull a fast one on consumers.
Smart investors should consider investing in NTUC Income, you could get a dividend yield up to 5% p.a.
Can't beat them, may as well join them, and have a share of the spoils. But you have to be their policy holder in an insurance scheme first.

Lye Khuen Way said...

The Insurance industry is getting into the habit of denying liability.
Why so?
Maybe, it is because almost every one do not believe in honest, fair dealing anymore.

Am I too brash and unfair myself?

I did state "almost everyone ".

As a aside, this concept of "fair dealing" even in our laws, got twisted when put into "practice ".
Am referring to the strange interpretation by the Commission in charge which seems to have directed the SMC for example, to remove their list of guideline for procedures.

We then get a case of "over charging " levelled at Dr Susan Lim! What nonsense, if you ask me.

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