Why Claims Get Rejected - and the Fix

The Ombudsman for Short-Term Insurance receives over 11,000 complaints per year - and rules in favour of complainants in roughly 39% of finalised cases. The patterns are predictable. Here is what causes rejections and how to prevent them.

The top 6 rejection reasons (Ombudsman data)

Non-disclosure at inception - undisclosed prior claims, modifications or licence endorsements. 38% of all rejections.

Driver not authorised - unlicensed driver, expired licence, learner without supervisor. 21%.

Tracking device inactive - signal lost, battery flat, contract lapsed. 14%.

Alcohol over the limit - automatic rejection if blood alcohol exceeds 0.05g/100ml (0.02 for professional drivers). 9%.

Vehicle used for unauthorised purpose - business use on private cover, e-hailing, courier. 7%.

Late notification - claim reported after the policy's notification window (typically 30 days). 5%.

The disclosure principle

South African insurance law requires uberrimae fidei - utmost good faith. You must disclose any material fact that would influence the insurer's decision to accept the risk or price it. This includes: prior insurance cancellations, criminal convictions, vehicle modifications (suspension, exhaust, ECU), previous claims (at fault or not), and any other regular driver.

What to do at the scene

Report to SAPS within 24 hours and obtain a case number - mandatory for theft/hijacking and for any accident with injury.

Photograph all vehicles, registration plates, the scene, damage, and skid marks.

Exchange details (name, ID, contact, insurer) but never admit liability in writing.

Notify your insurer within the policy window - 24-48 hours is best practice.

Do not authorise repairs before assessor approval.

The Ombudsman escalation path

If your insurer rejects a claim and internal appeal fails, the Ombudsman for Short-Term Insurance (ombud.co.za) provides free, binding adjudication for individual consumers. The process takes 4-9 months. Insurers must comply with rulings up to R2 million.

Pre-incident audit (do this annually)

Confirm tracking device test signal with the provider.

Update insurer with any change in regular driver, address, or annual mileage.

Re-declare modifications - even cosmetic wheel upgrades.

Verify policy schedule lists the correct vehicle VIN and engine number.

Save your insurer's emergency number in your phone and glove box.