Bukunmi Ogunwale: 7 Reasons Why Your Insurance Claims Are Not Being Paid

It is important to understand that buying insurance cover is a way of improving your financial balance. Especially in this time of economic downturn.

While you may not be able to start a savings plan for your property or self, you should at least be ready to protect the one you have.

However, many times I have heard complaints that insurance companies do not pay claims. All they do is collect your money, but when it is time to make payment when there is an accident they would turn you down and not pay your claim. Then I get confused when insurance companies advertise or publish their annual report and say they have paid so and so billion Naira on claims. So I wonder, are they paying all this billions to ghosts?

Which brings me to the subject. I realise that many claimants or customers of insurance companies do not get paid when there is an accident for these reasons.

You have Not Paid for the Insurance, But You Have the Insurance Document
Now if you have not paid for a service how do you expect to benefit from that service? Insurance in Nigeria as it stands today is only for those who have made payment. If by any means someone gives you your motor certificate and you still promise to pay, my dear that certificate is not valid because if you damage someone’s vehicle you are on your own (OYO). So ensure you pay your premium. If you think you are outsmarting the insurance company, just wait until there is an accident then you will know what karma is.

You Bought a Fake Insurance Policy from Your Vendor
I see many people buy third party insurances from every Tom, Dick and Harry. Many of these certificates you buy are fakes. When you buy these insurance premiums, omo na fake you buy o! When you have a claim, no show for you. Any time you want to buy motor insurance always ask if you can verify on NIID. In fact you can refuse to pay until you confirm your vehicle can be verified on the platform.

You Have Bought the Wrong Type of Insurance
Let me use this analogy. A size 42 shoe is useless to someone whose feet is size 36 isn’t it? It’s the same way with insurance. Most insurance products are tailored to cover specific risks, so be careful to buy the product that suits your need. For example, if you know you can sometimes have liquidity issues, why buy a third party motor insurance when you can buy a comprehensive cover that can compensate you for damage to both third party and yourself.

Your Claim is Fraudulent
Many times insurance companies have been forced to turn down claims because they are fraudulent. Imagine someone submitting a fake affidavit or fake police report. If during investigation of a claim it was discovered that your claims documents are fake, even though a loss as really happened, the insurance company could refuse to pay  –  on the ground that the claim is a fraud from the outset.

You Bought the Right Cover but The Accident is Not Covered by The Policy
I always advise clients to read their insurance policy document properly and ask questions. If you think you cannot understand what is written in the document (most insurance companies now use contemporary-easy to read English and legible lettering for their documents) ask a professional to walk you through. Tell them to explain the exclusions, warranties and clauses. This is necessary to help you understand what your policy covers. For example if you currently live in Ghana and you have bought a fire policy for your home it is important to verify if this policy covers flood, as flood damage to property may be excluded on your policy. Hence submitting a claim for flood damage may be turned down by the insurance company.

You Do Not Have Insurance Cover At All
I have seen people who, because they did not have a claim the previous year, refuse to renew their policy in the following year – until when a claim has occurred then they quickly make payment for the new year in the hope that their insurance company would pay the claim. The thing is, you did not have insurance cover during the period when the claim occurred so your insurance company may refuse to pick up the claim.

You Don’t Document Your Claims Properly
Oh this is very common, I don’t have actual statistics but more than 50% of claims processes are delayed and drag out for too long before payments are made, because the client did not document his claim properly. The onus to report your claim and document it, is on you (if you want to get paid).  Don’t slack or make it more difficult. You have paid for this service, you should make your life easier and bitter experience of enduring a loss shorter by documenting your claim properly in order to speed up claims payment.

Now I have only listed the most common causes why you have not been compensated for your loss by your insurance company and I hope this article would help you become more attentive to your insurance purchase.

However, sometimes even when you have documented your claims badly or had a loss outside of your insurance period the company may consider your person (that is business records, claims and premium payment history or any other consideration) and still go ahead and compensate you for your loss on Ex-gratia (goodwill) basis. This means the company accepts to pay you for reasons outside the contract you already had with them.

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