Sober up on insurance policy facts

Most motorists who consume alcohol before driving a vehicle consider police detection to be the greatest threat to their illegal behaviour.

They take the roads less travelled to avoid the consequences of their unlawful behaviour, relieved, when they arrive home, without being caught.

“But many motorists fail to consider the devastating financial effect that driving drunk may have on a pay-out from their insurer should they be involved in an accident.

This is because the majority of policies exclude cover for any damage where an insured driver was found to be under the influence of alcohol or drugs at the time of an accident or that the percentage of alcohol in their blood exceeds the legal limit,” the Ombudsman for Short-Term Insurance (OSTI), said.

In criminal cases, the state is required to demonstrate beyond reasonable doubt that a driver was indeed driving drunk.

In civil cases, however, such as claims under an insurance policy, the insurer need only show that the insured was, on a balance of probabilities, driving under the influence.

The insurer does not need to depend entirely on the results of a blood test or Breathalyzer confirming that the driver was over the legal limit when the accident occurred.

It is enough to sway the probabilities in its favour if the insurer is able to produce circumstantial evidence to demonstrate that the driver was drunk.

Circumstantial evidence insurers often depend on, are statements by police or emergency service personnel at the accident scene, doctors or nurses who attended to a driver who was admitted to hospital and eye witness accounts, for example, security or video footage from restaurants or bars.

If the circumstantial evidence establishes on a balance of probabilities that a driver was under the influence when the accident occurred, the ombudsman will support the insurer’s decision to reject the claim.

Another common exclusion found in insurance contracts is an entitlement on the part of an insurer to reject a claim if a driver unlawfully leaves the scene of an accident.

Section 61 of the National Road Traffic Act requires a driver involved in an accident where a person or animal is killed or injured or any property (including another vehicle) is damaged: to stop the vehicle and report the accident; to ascertain any injuries sustained to a third party and if there is an injured person, to render, where possible, any assistance; to ascertain the nature and extent of any damage sustained; to request the details of the insured; to report the accident within 24 hours (unless prevented from doing so by injury) and not to take any alcohol or drugs until the accident has been reported to the police, where it is required by a traffic officer, or a medical practitioner.

Failure to comply with these conditions will entitle the insurer to reject a claim which the Osti will uphold, if it can be shown that the driver failed to adhere to any of the provisions.

Claims may also be rejected when an insured provides an insurer with incorrect or dishonest information about the events leading to the crash.

In one complaint, the insured informed the insurer that he had visited his sister at her house immediately before the crash; he was alone in the vehicle and on his way back to a guesthouse where he planned to spend the night, when the accident occurred.

The accident occurred at 2am on a Sunday.

The man said he was driving at 50km/* on a dual carriage road when a vehicle came into his lane from the left side and hit his mirror. As a result he lost control of his vehicle and collided with an island in the middle of the road.

The insurer’s investigations show- ed that the motorist had been at a nightclub before the accident and he had two passengers in the vehicle.

As the insurer was unable to investigate the claim properly after the accident, the insurer was prejudiced and declined to pay the claim.

The insurer’s decision to reject the claim was upheld by the ombudsman, who said the exclusions do not give insurers the right to reject a claim, but policies usually contain an exclusion against liability for loss or dam- age to a third party’s vehicle or property.

This means that you will be re- sponsible, not only to repair your own vehicle, but you may have to pay for damage to a third party’s property and the financial implications could be too ghastly to contemplate.

Moreover, you will be required to disclose these facts to another insurer who may decide to reject your insurance application.

So the moral of the story is don’t drink and drive. And, the Osti warned, be aware of the risks of driving an insured vehicle while under the influence of alcohol or drugs, unlawfully fleeing the scene of an accident or providing an in – surer with dishonest information.

* Contact the Osti on 011 726 8900 or email info@osti.co.za, alternatively visit the website on www.osti.co.za to find out more.