Insurance Case Studies

Unauthorised Driver

Lisa loaned her motor vehicle to her cousin Mark to drop some friends to Matura. After dropping them off, Mark drove to his aunt’s house, properly secured the motor vehicle in the driveway opposite and went inside to rest. Upon awakening, he realized that the motor vehicle was missing. A neighbour mentioned that she saw his two (2) younger cousins driving off with the motor vehicle. Mark reported the incident to the police and the motor vehicle with damages to the front was later recovered.

Lisa was scheduled to leave the country the day after the incident and as such did not make a report to her insurance company until a few months later. Upon concluding its investigation, the insurance company determined that Lisa did not have a claim and that it was a family matter. Lisa did not agree with the determination of the insurance company and thus visited the Office of the Financial Services Ombudsman (OFSO).

The OFSO in following its process requested an investigation report from the insurance company. The OFSO was informed by the insurance company that while the motor vehicle was taken without permission they did not agree that it was stolen because it was taken by persons known to both Mark and Lisa and there was no intent to deprive the owner of her property. The insurance company found that the accident was caused by an unauthorized driver- one without a license to drive as well as permission to drive. As such, the claim was denied. The OFSO communicated this to Lisa and she was informed that if she still disagreed with the insurance company she could provide additional evidence to support her claim. Having not received any further information from Lisa, the file was closed.

Lessons Learnt:

1. It is important to read all terms and conditions of your motor vehicle insurance policy. Most policies will not honor claims where the person driving the vehicle is not authorized.

2.  In addition, according to the Motor Vehicles and Road Traffic Act, Chap 48:50 (M.V.R.T.A.) Sect 74 (1) (a): 

     You must not use a vehicle without the consent of the owner

                                             and

Sect 42 (1) (a) of the M.V.R.T.A:

You must be the holder of a driving permit valid for the class of vehicle you intend to drive.

 

Driver initially accepts liability; Wrong Insurance Company Targeted

On the second day of the New Year, Karen was driving in her Honda Accord motor vehicle when, according to her, a motor vehicle driven by John collided with her vehicle. John accepted liability at the time of the accident and agreed to pay for the repairs to her motor vehicle. Karen was dissatisfied with the repairs claiming that the foreign used parts used to repair her vehicle changed its appearance externally and its functioning internally. Karen also wanted payment of $5,000.00 for loss of earnings as a result of the accident.

It was at this point that Karen visited the Office of the Financial Services Ombudsman (OFSO) for assistance. Karen requested that this Office communicate with John’s insurance company to recover expenses related to repairing the motor vehicle and loss of earnings. The OFSO sent communication to the insurance company as indicated by Karen. However, upon investigation, it was discovered that John was not insured by that insurance company and as such it had no record of the accident. The company also attempted to contact Karen numerous times but was unsuccessful.

When contacted by the OFSO with the insurance company’s response, Karen indicated that she was mistaken and that John was in fact insured by her own insurance company. Karen confirmed that her motor vehicle was finally repaired but her claim for loss of earnings was not as yet settled. Given that there was no further indication from Karen that she wished to continue the matter with her insurance company, the file was closed.

Lessons Learnt:

1. Report your accident to the police- it is the law!

According to the Motor Vehicles and Road Traffic Act, Chap 48:50 (M.V.R.T.A.) Sect 79 (1):

If involved in an accident which causes damage or injury to person, vehicles or property or any animal not in your vehicle, you must stop, take the injured to the nearest doctor or hospital, give your name and address to interested persons and report the accident to the nearest Police Station or to a constable in uniform immediately.

2. It is always advisable to report the accident to your insurance company and to the other party’s insurance company even if the person admits liability at the time of the accident.

3. To expedite the claims process, ensure that correct information is relayed to the insurance company and the OFSO.

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