How a tyre and rim cover claim works, and what you can do if it is refused

A claim on a tyre and rim plan follows the steps in the plan terms: report the damage, supply the proof the plan asks for, and have the work done as the plan allows. If the plan is insurance, the Policyholder Protection Rules set duties for how the insurer treats your claim. Olvian does not handle claims.

What do you need to know before you ever claim?

The time to learn how a claim works is before the damage happens. When the licensed provider calls, ask for the claims steps in writing:

• How and where do I report damage, and how soon after it happens?
• What proof do you need, such as photographs, the damaged tyre or rim, or an inspection?
• Do you inspect before I replace the tyre or rim?
• Who does the work, and do I pay first and get refunded, or does the plan pay the fitment centre directly?
• Is there a limit per tyre or rim, a limit on claims in a year, or a waiting period?

If the plan is an insurance policy, the insurer has to tell you much of this. Rule 17.8.3 of the Policyholder Protection Rules (Short-term Insurance) says an insurer must disclose to a claimant the type of information required, where, how and to whom a claim and related information must be submitted, any time limits on submitting claims, any excesses payable, and details of any administrative fee payable in relation to managing the claim. Rule 17.8.2 requires all communication with a claimant to be in plain language.

What should you do when the damage happens?

Follow the plan terms. As a general approach, keep records: take photographs of the damage and the road or kerb where it happened, note the date, place and time, and keep any invoices. Do not have the tyre or rim replaced before you have checked what the plan requires, since some plans want to inspect the damage first. If you are not sure, phone the provider and ask, and write down who you spoke to.

Olvian cannot tell you what a particular plan requires. The plan terms and the provider do.

What happens after you report a claim?

For an insurance policy, Rule 17.8.4 says a claim is deemed to have been received on the day the insurer or its representative receives notification of it. The insurer or its representative must, within a reasonable time, acknowledge receipt, and tell you the contact details of the person or department processing the claim and indicative timelines for finalising it.

Rule 17.6.1 then says the insurer must accept, repudiate or dispute the claim, or the amount of it, within a reasonable period after receiving it. The Rules set no single fixed number of days for that decision. Once the insurer has decided, Rule 17.6.2 says it must notify you in writing within 10 days.

If the plan is not insurance, the contract and the Consumer Protection Act govern. Section 54(1) gives you the right to timely performance and completion of services, and timely notice of any unavoidable delay, and to services performed in a manner and quality that persons are generally entitled to expect. If a service falls short, section 54(2) lets you require the supplier to remedy the defect or refund a reasonable portion of the price.

What if your claim is refused or only part paid?

If the plan is an insurance policy and the insurer repudiates or disputes your claim or the amount, Rule 17.6.3 says its notice must, in plain language, tell you:

• the reasons for the decision, in enough detail for you to dispute them if you choose;
• that you may, within a period of not less than 90 days after the date of the notice, make representations to the insurer;
• the details of the internal claim escalation and review process;
• your right to lodge a complaint with the relevant ombud, with contact details and any time limits;
• any time limit in the policy for starting legal action, or, if there is none, the prescription period that applies under the Prescription Act 68 of 1969.

If you make representations, Rule 17.6.5 requires the insurer to notify you in writing of its decision to accept, repudiate or dispute within 45 days of receiving them. If it still repudiates, Rule 17.6.6 says its notice must again give reasons in enough detail for you to dispute them, the facts that informed the decision, and the information in Rule 17.6.3(c) to (f).

If the plan is not insurance, ask in writing for the reasons for the refusal and the clause it relies on. Section 48(1) of the Consumer Protection Act says a supplier must not supply services on terms that are unfair, unreasonable or unjust. If you think a term is, you can complain, as the next guide sets out.

What if a repair or replacement is done badly?

A tyre or rim replaced under a plan is goods, and the fitment is a service. Under section 56(2) of the Consumer Protection Act, within six months after delivery of goods that fail the standards in section 55, you may return them without penalty and the supplier must, at your direction, repair or replace them or refund the price. If a repair fails within three months, or another defect appears, the supplier must replace the goods or refund the price (s 56(3)).

Whether these sections reach your plan depends on who supplied what to whom. Ask the provider.

Where do you complain if it goes wrong?

Start with the provider, in writing. For an insurance policy, the National Financial Ombud Scheme can look at a complaint once you have lodged it with the insurer first, and its service is free to complainants. For a motor-industry supplier not covered by another ombud, the Motor Industry Ombudsman may help, and its service is free to consumers. You can also file a complaint with the National Consumer Commission. The FSCA is a regulator, not an ombud, so a claim dispute goes to the provider and then the ombud. The cancel-and-complain guide in this series has more.

What records help if you have to dispute a decision?

Keep everything: the plan terms, the photographs, the date and place of the damage, invoices, the names of people you spoke to and the times, and every message you send and receive. If a provider tells you something by phone, follow up by email and ask it to confirm.

If a decision is disputed, a clear record makes it easy to see what happened. If you have to complain to an ombud, they will ask for the paperwork and what the provider told you.

Do exclusions and limits have to be pointed out to you?

Yes, where they limit the provider's liability. Section 49(1) of the Consumer Protection Act says a notice or a provision of a consumer agreement that purports to limit the risk or liability of the supplier, to make you assume a risk or liability, to make you indemnify the supplier, or to be an acknowledgement of a fact by you, must be drawn to your attention in the manner the section requires. Under section 49(3) it must be written in plain language. Under section 49(4) it must be drawn to your attention conspicuously, in a form likely to attract the attention of an ordinarily alert consumer, and before you enter into the agreement or are asked to pay. Under section 49(5) you must be given an adequate opportunity to receive and comprehend it.

Section 51(1)(b)(i) adds that a supplier must not make an agreement subject to a term that purports to waive or deprive you of a right under the Act.

In plain terms: an exclusion or limit that matters should not be buried. If the provider reads the limits to you on the call, ask for the same words in writing. If you cannot find an exclusion the provider relies on later in the documents you were given, say so when you complain.

Who answers the judgement questions?

Whether a particular tyre or rim loss should be claimed on your plan, on your comprehensive policy, or not claimed at all, is not for Olvian to say. Olvian is a lead-referral service, paid a fee by licensed providers, and it is not an insurer, broker, FSP or adviser. The licensed provider who calls you can explain how their claims work, and your insurer can explain your policy.

Sources

• Policyholder Protection Rules (Short-term Insurance), Government Notice 1433, Government Gazette 41329, 15 December 2017: https://lawlibrary.org.za/akn/za/act/gn/2017/1433/eng@2017-12-15
• Tranche 2 amendments to the Short-term Insurance Policyholder Protection Rules, September 2018 (National Treasury): https://www.treasury.gov.za/twinpeaks/Policyholder%20Protection%20Rules%20and%20Supporting%20Document/Tranche%202%20amendments%20to%20the%20Short-term%20Insurance%20PPRs%20Sept%202018%20(track).pdf
• Consumer Protection Act 68 of 2008, Government Gazette 32186: https://www.gov.za/sites/default/files/32186_467.pdf
• National Financial Ombud Scheme: https://www.nfosa.co.za
• Motor Industry Ombudsman of South Africa: https://www.miosa.co.za
• National Consumer Commission: https://www.thencc.org.za
• Financial Sector Conduct Authority, Financial Consumer page: https://www.fsca.co.za/Financial-Consumer/