23/08/2008 15:41 - (SA)
Client outrage at Outsurance
Nhlanhla Ncaca
AN OUTSURANCE policy-holder, whose home was allegedly broken into three days after an assessor had visited her premises to investigate a separate claim, has accused the insurance company of double standards.
Kate Moodley of Johannesburg is at loggerheads with Outsurance after the company allegedly terminated her policy when she lodged a complaint against the assessor, who she accuses of stealing assets with an estimated value of R200 000.
Moodley feels that insurance companies need to exercise their duty to protect consumers from any further unlawful conduct especially after obtaining personal details that could be used to commit a crime.
She argues that on the basis that she disclosed to the assessor details of her most valuable assets, Outsurance should have probed the assessor instead of terminating her contract.
“They repudiated my claim on the basis of fraud and dishonesty ... and it is all lies,” says Moodley.
Moodley took out a short-term personal cover with Outsurance about five years ago, paying a monthly premium of R3 000.
In March, she renovated her house in Parkview. But thieves interrupted the renovations when they stole building materials worth R50 000 from her premises.
She submitted a claim, but Outsurance refused to settle on the basis that tthe insurance claim was fraudulent.
Moodley says she appealed the decision and Outsurance agreed to review the claim.
On June 5, an assessor was sent to investigate and by that time the renovations were complete, she says.
She claims the interview with the assessor turned into a comprehensive scrutiny of every item in her home, including the details of her security system.
“I found the assessor’s enquiry to be an invasion of my privacy but I complied in good faith. When he took photographs of all my valuable assets I cooperated.
“These are the same items that were later stolen,” she says.
Three days after the assessor’s visit, Moodley was attacked at her home, she explains.
She lives alone, but her mother had visited her on the day of the attack.
They were sitting around the garden when three armed men allegedly stormed into the yard.
Moodley says the robbers demanded the keys to her safe and when she explained that there was no safe, they demanded her jewellery.
The pair were held at gunpoint and their hands and legs were tied to chairs while the attackers ransacked her house.
The thieves stole assets valued at R200 000, including electric appliances, before escaping through the front gate.
Moodley said her experience was so bad that she was diagnosed with secondary post-traumatic stress. She later filed a claim.
Two assessors were appointed to look into the matter. She says she told them that she suspected the assessor who had visited her home earlier was behind the theft.
This, she claims, invited abuse from the two men, who accused her of lying and said she was trying to defraud the company.
Moodley says the assessors refused to allow her to read the statement they had taken from her.
On June 17, Moodley contacted Outsurance and lodged a complaint against the two for alleged ill-treatment. She further lodged a complaint against the assessor who had visited her earlier to investigate the first claim.
On June 19, Moodley submitted a written complaint to Outsurance, substantiating her allegations against the assessor.
The following day she received a call from an Outsurance consultant, who informed her of the decision to terminate her policy.
On June 25, Moodley received an email from Outsurance informing her of the findings of an internal investigation of her complaints.
A bitter battle between Outsurance and Moodley ensued over her allegations.
“I found it strange that Outsurance completed its investigations in just two days.
“To me it indicates a total lack of interest on the part of Outsurance in dealing with possible crime, fraud and misconduct within its organisation.”
Despite her appeal, Outsurance refused to reinstate the policy.
She has since referred her complaint against Outsurance to the Financial Services Board (FSB).
She believes that the insurance company failed to comply with the financial service providers’ code of conduct.
“A provider must at all times render financial services honestly, fairly, with due skill, care and diligence in the interest of a client.
“Outsurance has contravened every element of this requirement,” she says.
The FSB has acknowledged receipt of the complaint and told Moodley that the matter was under investigation.
A letter in Hotline’s possession partly states: “We will notify you of the outcome of the investigation.”
Meanwhile Outsurance has denied that Moodley was coerced into making a written statement.
Outsurance managing director Ernst Gouws says there is no indication that undue pressure was applied.
“The client’s recount of the matter is incorrect. She may contact any regulatory body and we will respond accordingly,” says Gouws.
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