Ombud navigates pandemic-era accident claims
New rules under the National Road Traffic Amendment Act will effectively introduce the total prohibition on the use and consumption of alcohol by all motor vehicle operators on public roads.
BusinessTech reports that the Bill was introduced in May 2020 and is being deliberated by lawmakers.
Currently, drivers are still able to operate a vehicle if they’ve been drinking, as long as their blood alcohol content is below 0.05 grams per 100 millilitres, and breath alcohol concentration below 0.24g/1 000ml.
Despite this, insurers include very explicit exemptions in policies stating that motorists are not covered for incidents where the driver is clearly under the influence of alcohol and drugs, has a concentration of alcohol in their blood exceeding the legal limit or fails a breathalyser test.
When rejecting insurance claims, the insurer bears the burden of proving the exclusion.
With the Covid-19 pandemic, the use of breathalyser tests has dropped off the list of tests officers can administer on the scene of an accident.
This had led to insurers having to rely on circumstantial or witness evidence to make determinations in claims.
The Ombudsman for Short-Term Insurers (OSTI) has highlighted two recent case studies where it had to step in and iron out the process and make a call based on the more limited evidence at its disposal.
Both cases involved accidents where the driver’s claims were rejected by their insurance companies and were sent to the ombud for assessment.
Without hard evidence to go on, the ombud had to rely on witness accounts and interviews to determine the truth.
In the first case, it upheld the insurer’s rejection of the claim and in the second it overturned the insurer’s rejection of the claim.
The ombud said that with both cases, it had to rely on witnesses in lieu of hard evidence to help determine the outcome.
‘The OSTI considers all the evidence presented by both parties to the dispute as well as the specific policy terms and conditions,’ it said.
The OSTI pointed out that the considerations of fairness and equity only have application in exceptional and warranted cases.
Often, the applicable legal principles are adequate to resolve disputes.
Article disclaimer: While we have made every effort to ensure the accuracy of this article, it is not intended to provide final legal advice as facts and situations will differ from case to case, and therefore specific legal advice should be sought with a lawyer.
