Secondary

Osti driving with glasses V2

Claim rejection must be supported by an exclusion in the policy

The Ombudsman for Short-term Insurance (Osti) told an insurer to settle claim from a policyholder who was not wearing his glasses at the time of an accident, despite the endorsement to his driver’s licence.

The policyholder claimed for the damage to his vehicle due to an accident.

The insurer rejected the claim for two reasons:

  • The insured did not have a valid driver’s licence; and
  • The insured was not wearing prescription glasses at the time of the accident, although his licence is endorsed requiring him to wear glasses. The insurer argued that the accident could have been avoided if the insured had been wearing his glasses.

The policy excluded cover if the vehicle was driven by a person:

  • With a licence that’s endorsed for drunken or reckless and negligent driving.
  • Without a valid driver’s licence or permit for the specific car type.

The Osti’s findings

The insured provided the Osti with a copy of his driver’s licence, which indicated that his licence is valid until 18 August 2022. It was therefore incorrect for the insurer to argue that the insured did not have a valid driver’s licence.

The first point in the policy exclusion clause refers specifically to drunken or reckless and negligent driving. There was no evidence to suggest that the complainant’s licence was endorsed for drunken or reckless and negligent driving. Therefore, the insurer was not entitled to rely on this point in the clause to reject the claim.

The insurer’s statement about the validity of the licence was not substantiated by the policy nor any legislation, nor did the insurer supply any evidence suggesting that the insured’s non-compliance rendered his licence invalid.

The insurer reiterated that the policy required that the insured comply with the National Road Traffic Act and further required that the insured be in possession of a valid driver’s licence to have cover. According to the insurer, it remained indisputable that the insured had failed to comply with the Act.

The Osti pointed out that the policy does not include an endorsement for a restriction on glasses/contact lenses. On that basis, the insurer had not provided any proof that the exclusion on which it sought to rely applied in the circumstances, and it had therefore failed to discharge its onus.

The insurer agreed to abide by the Osti’s provisional ruling and settled the claim.

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