Saying it is a claim is one
thing, but proving it is another!

In practice, the onus of proof is a critical question to resolve a claim.

A claimant who wants to claim under a policy bears the onus of proving that an insured peril caused the loss.

Once you have demonstrated that you have a valid claim in terms of the policy wording, the insurer will process the claim.  However, if the insurer does not agree that you have a valid claim, the Onus of Proof shifts to the insurer to demonstrate that the loss is not covered in terms of the policy.  If the insurer discharges the Onus of Proof to show that an exclusion applies to deny or limit your claim and you do not agree with the outcome, the Onus of Proof shifts back to you to show that the insurer’s decision was wrong.

Herewith two practical examples of onus of proof:

Example 1:

A policyholder crashes their vehicle on their way home from a late-night event.  A police case number was provided when submitting the claim, which provides proof of the accident, therefore the accident is covered under the policy and the insurer will have to treat the claim as valid.

If the insurer suspects that the insured was driving under the influence of alcohol or drugs (an exclusion on all policies) and wants to repudiate the claim, they will have to prove this suspicion beyond a reasonable doubt.

Example 2:

In the event of theft of your assets, the insurer will always require a police case number to verify that the theft happened.  The police report will also contain information regarding the circumstances.  The insurer may ask for proof of ownership and will always ask what the items were worth.  Some insurers are very particular about the documentation they will accept as proof of ownership, for example, purchase receipts and valuation, while others may be more flexible.  It is best to check with your insurer regarding acceptable proof in the event of a claim.

If you have any questions, get in touch with us today.

Although all possible care was taken in the drafting of this document, the factual correctness of the information contained herein cannot be guaranteed. This document does not constitute advice and anyone planning on taking any financial action based on this document is strongly advised to first consult with their personal financial advisor. ProVérte Risk Management is an authorised financial service provider with FSP no. 51584.

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