Answering 10 Of The Most Common Claims Questions

Insurance Claims Explained: 10 Must-Know Questions for South African Drivers

Confused about how to file an insurance claim in South Africa? You’re not alone. 

After a bumper bash that may or may not be your fault, your first instinct might be to panic. Questions like, “How much will the repairs cost?” “Does my insurance cover this?” or “Why does this always happen to me?” can crowd your thoughts.

Unfortunately, in the heat of the moment, it’s easy to forget what needs to be done to file a successful insurance claim.

Pineapple believes that understanding your insurance claims process should be easy. That’s why we’ve compiled the 10 most frequently asked questions about insurance claims and answered them in plain language—no confusion, just clarity.

Here’s what we’ll unpack:

• Why insurers ask so many questions during a claim
• The essential information you need when submitting claims
• What to do after filing a claim (next steps)
• How Pineapple makes the claims process simple

If you’ve recently been in an accident and don’t know what to do, the following guide should help: What To Do If You’re In A Car Accident: A Step-By-Step Process.

TL;DR – Our version of “I’m not reading all that, *SparkNotes pls.”

• Review your insurance policy to understand what’s covered and what’s not, helping you avoid surprises when making a claim.
• Keep all relevant documents, including photos, police reports, third-party details and any relevant receipts and/or towing slips, organised and ready to submit—this speeds up the process and supports your claim.
• Stay in touch with your insurer throughout the claim process, providing any additional information they request to ensure a smooth experience. However, it’s also beneficial to acknowledge that the insurer may request any reasonable information and/or documentation in order to validate a claim.
• Claims can be accepted, adjusted, or even repudiated—knowing your rights and options can help you respond effectively. 

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Why Do I Still Pay Excess If I’m Not at Fault?

TL;DR: Excess is the first amount payable in the event of a claim, and should the claim be successful, the insurer can initiate an attempt to recover.

Insurance providers don’t use blame to determine whether you must pay an excess. 

But it’s completely normal to wonder why you must pay the excess fee even if an accident isn’t your fault. 

The short answer is, and as mentioned, that an excess is required for all valid claims, unless there is a ‘no-excess fee’ applicable, as an example, with Pineapple, if someone is a pensioner and not gainfully employed. This is regardless of who’s responsible for causing an accident. 

The idea is to share the risk between you and your insurance company. Having to pay an excess fee when submitting a claim helps policyholders claim responsibly, and not for all minor damages. Also, taking into consideration that any claim on a comprehensive motor policy, excluding windscreen, will affect your risk profile.  

Submitting multiple claims in a short amount of time can cause your monthly insurance premiums to increase because your risk has increased. However, also take note that even though the frequency may not be excessive, high quantum claims also affect your risk profile. In extreme cases, your insurance provider can cancel your policy because 

If you’re insured with us and the other driver is at fault, Pineapple may attempt to recover this excess on your behalf. 

But, this doesn’t mean we’ll be successful in retrieving the amount, especially if the at-fault driver is one of the more than 60% of South African motorists who aren’t insured. 

Why So Many Questions When I Submit a Claim?

Insurance providers often ask a laundry list of questions when you submit a claim. It can feel like you’re being grilled in an interrogation. 

However, there’s a reason for that.

Insurers may ask many questions because they need to know precisely what happened to fully understand and validate the merits of the claim. The more insight they have on a claim, the better and quicker they can assess the merits and finalise the matter. 

Here are a few other reasons why insurers ask a lot of questions:

1. Fraud prevention.
   Some people try to cheat the insurance system by deliberately failing to disclose prior claims. So, asking questions ensures everything adds up. It’s the only way to double-check the incident to protect the client (a.k.a honest customers like you) and the insurance company from fraudsters.‍
   
   
2. Regulatory and legal compliance.
   Insurance providers also have to follow specific laws and regulations. This means we must gather enough information to comply with these rules and ensure everything’s above board.
   
   
3. Accurate claims assessment.
   Every client’s claim must undergo a validation process to ensure that all the information is factually correct. This information is then used to validate the incident and the version of events leading up to the loss.
   
   
4. Third-party recovery.
   If you weren’t the cause of the accident, the info you provide about the other driver helps our team recover the costs of the incident and potentially get your excess back. 

Lastly, it may sound counterintuitive, but asking questions surrounding the incident you’re claiming for can actually help resolve your claim in the least amount of time.

By getting all the information, insurers can avoid a back-and-forth later on. If the validation process is not done right at the beginning of the claim submission, it can slow down the entire claim process.

Am I Covered If the Accident Was My Fault?

With comprehensive car insurance, you’re covered for damages to your vehicle regardless of who’s at fault in an accident, e.g. a minor bumper bashing on wet roads, or misjudging a turn. You’ll just have to take care of the excess amount, if applicable. 

The beauty of a comprehensive car cover is that we’ll pay you out even if you’re at fault in an accident.

There could be instances where an insurer may reject a claim. 

A few examples include if you tread into illegal territory, like driving drunk, acting in a grossly negligent manner behind the wheel, having an endorsed or invalid driver’s license, or cruising around in an unroadworthy car, to name a few.

So, in a nutshell, yes, you can be covered even if the accident was your fault. Still, the extent of that coverage and the financial implications depend on your specific insurance policy and its terms. 

So, you know that policy document you’ve been avoiding? It’s time to start reading it now!

If you only have third-party cover, your insurance only covers damages to the other vehicle, leaving you responsible for paying for your own car’s repairs. 

Learn more about different types of insurance cover in our other guide, The Different Types Of Car Insurance In South Africa: What’s Best For You!

Understanding Additional Excesses in Your Car Insurance

Additional excesses are often applied to specific scenarios or high-risk factors, like young drivers under 25. These excesses reflect the increased risk and potential cost associated with these factors.

They’re a way for insurers to balance risk while offering coverage to a broader range of customers.

A policyholder could also pay the basic excess plus the Standard Additional Excess. However, this would only be if the car’s retail value does not exceed 20% of the vehicle’s retail value. If it exceeds 20%, Pineapple will cap it at 20% of the retail value.

What You’ll Need to Submit a Claim with Pineapple

Here’s what you’ll need to submit a claim with Pineapple:

• Your policy number
• Details about the incident (e.g., date, time, and location)
• A description of the incident
• The other driver’s information (if a third party was involved)
• Relevant documents, i.e. police report, witness statements, or photos and videos.

But rest assured, your Pineapple claims advisor will guide you through the steps to validate your claims. Speaking of steps, here’s how to file a claim once you’ve gathered all the necessary information. 

How to File an Insurance Claim in 5 Easy Steps

Steps to Submitting a Claim with Pineapple (depending on the item you’re claiming for):

1. Log onto the Pineapple app. If your phone has been stolen, you can submit a claim through the website (pineapple.co.za).
2. Navigate to the claims flow.
3. Confirm that you will be honest in all your questions.
4. Select the date on which the incident occurred
5. Select items that were affected.
6. Select if the incident was a theft or a damage event.
7. Submit a voice note explaining what happened.
8. Use our Google Maps integration to show us where the event occurred.
9. Upload as much supporting documentation as possible or take pictures of evidence.
10. If you have a case number, please provide it to us.

Finally, review your information and hit submit.

Is Car Hire Included in My Insurance Policy?

With Pineapple’s comprehensive car insurance policy, you have the option to add car hire, or a courtesy car, and credit shortfall to your policy. This is an optional extra, so it comes with a small additional premium on top of your standard monthly insurance premium.

You can select the group of vehicles to be hired and the period of car hire.  The following options are available:

• 30 days
• 45 days
• 60 days

However, you must add car hire to your policy before the claim stage, as “NO EXTENSIONS” will be provided at the claim stage. 

If you think this is finally your chance to trade in your entry-level Polo for your dream Mercedes, even if it’s just for 60 days, think again. You cannot upgrade to a pricier vehicle or one of a different group than the one you initially chose.

But car hire isn’t a free-for-all. You must first submit a claim for your damaged or stolen car. Once that claim’s approved, we’ll organise the courtesy car on your behalf with our rental partner.

On your side, you’ll be responsible for:

• The car’s fuel.
• Any traffic fines or toll fees incurred while you have the vehicle.
• A refundable security deposit or excess amount required by the rental company.

Drive Confidently — You’re Covered

An insurance claim is a sensitive and stressful time. Thankfully, our team has worked hard to make the process as painless, transparent and efficient as possible. With the right knowledge and a helpful insurance provider like Pineapple, the process can be as pleasant as a claim can be.

And if you take nothing else from this piece, do me a favour and remember these key takeaways:

• Always report a claim promptly, ideally within the time frame specified in your policy document.
• Be ready with the relevant documents and details.
• Know your insurance policy’s excess amount, additional excesses and any limits.

Pineapple has your back and your bumper; we’ll make it our top priority to get your claim resolved in no time.

Don’t have insurance yet? Get a quote for Pineapple’s affordable comprehensive car cover now!

Top 10 Insurance Claims FAQs

1. How long after an accident can you claim from insurance?
   Pineapple’s insurance T&C’s state that if an event happens that is likely to result in a claim, you must notify us as soon as possible, but no later than 30 days from the incident date. You risk losing your right to lodge a claim if you don’t. You must also notify the police of any traffic accident or incident involving a crime (for example, theft or deliberate damage) within 48 hours of the incident.

2. How long does it take for a claim to pay out?
   How long it takes for a claim to be paid out depends on the claim’s complexity; simple cases can be resolved in a matter of days, while complex claims can take longer. Factors that can influence the swiftness of a claim’s resolution are the completeness of your documentation, the need for more in-depth validation, and any backlogs the insurance provider may be experiencing.
   
   

3. What is my “excess” payment?
   An excess is the first amount payable in the event of a valid claim. This payment is a standard feature of insurance policies, and is usually a fixed amount or a percentage. Your selected excess directly affects your monthly insurance premium; the higher the excess, the lower your premium and vice versa. 
   
   
4. How many claims can I make in a year?
   You’re not restricted to any number of claims in a year. And while insurance providers typically don’t limit the number of claims you can register, too many can negatively affect your policy. Filing a lot of claims in a short period can signify a high-risk individual. Even if each claim is low in value, if you’re claiming car insurance often, this may affect your premiums.
   
   
5. How do claims affect my future premiums?
   A claim lodged after a long period of remaining claim-free likely won’t significantly increase your monthly insurance premiums. But if you’re claiming frequently, this may result in higher premiums or even non-renewal of a policy, because insurers see you as a higher risk, even if each claim is low in value.
   
   
6. Does claiming affect my credit score?
   No, claiming from your insurance provider does not directly affect your credit score. Insurance providers use a different database to track claims history, not your credit report from the credit bureau. But claiming frequently creates a pattern that will be noted, leading to higher premiums and potentially cancelling your policy.
   

7. What happens if an accident is not reported within 24 hours?
   Failing to report an accident resulting in a fatality to the police is a criminal offence and could land you behind bars. You may face prosecution or receive a written notice to appear in court.
   
   

8. What are the stages of the insurance claim process?
   The specific stages in a claim process will depend on the insurer you have cover with, and the insurance policy itself. 

9. What documents will I need to submit a claim?
   When submitting a claim to Pineapple, you must provide:

   1. Full details of the event.

   2. We may ask you for all the information and assistance you need to obtain compensation from a third-party driver.

   3. Information relating to any other insurance policy covering the same event.

   4. Proof of purchase, ownership and value statements and any other information we may need within our specified timeline (this may vary from 2 to 14 working days depending on the circumstances of the claim).

   5. The damaged item you are claiming for (if requested)

   6. Any correspondence or documents you have received concerning the claim (for example, court papers or legal letters).

10. Can my insurance company refuse a claim?
Yes, an insurance company can refuse or reject a claim. Here are some reasons why your claim may be denied:

• Policy exclusions and/or not following the policy terms and conditions.
• Materially providing incomplete or inaccurate details at claims stage.
• Omissions or inaccuracies in your insurance application.
• Failing to take ‘reasonable care’ and/or precaution to prevent or minimise loss.
• Gross negligence.
• Fraud/Dishonesty.

That said, here’s an overview of Pineapple’s claim’s process:

1. Log onto the Pineapple app (If your phone has been stolen, you can submit a claim through the webpage).
2. Navigate to the claims flow.
3. Confirm that you will be honest in all your questions.
4. Select the date on which the incident occurred
5. Select items that were affected.
6. Select if the incident was a theft or a damage event.
7.  Submit a voice note explaining what happened.
8. Use our Google Maps integration to show us where the event occurred.
9. Upload as much supporting documentation as possible or take pictures of evidence.
10. If you have a case number, please provide us with it.

In the event of a claim, you must notify Pineapple as soon as possible, but no later than 30 days from the date of the incident. Give full details of the event and any information we may ask you for.

Please Note: The information provided above is for informational purposes only; you should not construe any such information as legal or financial advice. 

Pineapple (FSP 48650) is underwritten by Old Mutual Alternative Risk Transfer Insure Limited, a licensed Non-Life Insurer and authorised FSP. T&Cs apply.