The latest Ombud Briefcase contains a number of case studies which provides guidance on key aspects of the industry.
Non-disclosure of a criminal record
A direct insurer rejected a claim on the above grounds. The Ombudsman found that the insurer had created a situation where the insured was led to believe that her criminal conviction was not material and that therefore, there was no duty upon her to disclose it.
Second hand parts used in repairs
Subject to certain limitations, using second hand parts to repair a vehicle is acceptable. The insurer argued that it was entitled to use second-hand parts as it was essentially swapping “like for like”.
Proving ownership of inherited jewelry
This case highlights the importance for clients to obtain updated valuations on items, or run the risk of not being reimbursed for the actual loss.
Claim rejected after being used for commercial use
The client should clearly understand the distinction between the terms “business use” and “commercial use”. The Ombudsman pointed out that the insurer had failed to prove that the claimant intentionally failed to disclose the type of commercial activity he was conducting, and that they had not created a duty of disclosure on the insured.
Insufficient evidence cannot justify repudiation of a claim
Quite frankly, this case is so bizarre, I would rather you read it yourself. If I expressed my view, I could be facing a libel suit.
These are but some the very informative situations discussed in the OSTI Newsletter 2/2015. Happy reading.