Short-Term Insurance and Personal Liability Explored
Article By Luke Fraser
We look at drinking and driving in South Africa and how the criteria for civil versus criminal cases can differ, as demonstrated by a dispute brought before the Ombudsman for Short-Term Insurance (OSTI).
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In the OSTI’s annual report for 2022, Assistant Ombudsman Abri Venter looked at a matter where an insurer rejected an insurance claim on the basis that the driver was intoxicated at the time of the crash.
The dispute was based on whether the insurer had enough evidence to prove that the driver was intoxicated.
The insured rear-ended another vehicle, causing damage to both vehicles.
Although a criminal case was opened, the prosecutor would later withdraw it.
The insured driver said there was a lack of evidence to prove that they were driving under the influence, arguing that the insurer could not uphold the rejection following the withdrawal of the criminal case.
The insurer said that it rejected the claim on the basis that the accident was caused by the insured being intoxicated.
Moreover, it claimed that the insured was not forthcoming with information until the assessment stage.
Venter said that the burden of proof is one of a balance of probabilities, which is far less intensive than a criminal case, where the state must prove that the case is beyond a reasonable doubt.
Despite the criminal case being withdrawn, this had no bearing on the civil case, as they both require different burdens of proof. The state could also still reinstate criminal proceedings at any time.
The policy wording that the insurer relied on to reject the claim did not require the insurer to only consider a blood test.
The policy exclusion said that the insurer is not liable for:
“Loss or damage as a result of the insured being under the influence of alcohol, drugs or any other substance not prescribed by a registered medical professional.”
The insurer could thus use factual evidence, such as witness testimony and documentary evidence, to show that, on the balance of probabilities, the insured was under the influence of alcohol at the time of the accident.
Therefore, the lack of a blood result is not material to the claim’s rejection.
The OTSI said that the insurer’s prima facie case, including independent witness accounts, proved that, on the balance of probabilities, the insured’s driving ability was impacted by the consumption of alcohol.
In terms of the insured’s misrepresentations, the insurer gave evidence showing that the insured’s version of events did not match the facts established during an investigation.
This gave the insurer another reason to decline the claim, as the insured did not provide true and honest information.
The OSTI thus decided to uphold the insurer’s decision to decline the claim.
Article credit to BUSINESSTECH.
Read Also: New Driving Rules Proposed For South Africa
What is your view on insurance claims being repudiated based on the insured being under the influence at the time of the accident? Let us know in the comments below. Also, if you found our content informative, do like it and share it with your friends.
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