An Appeal Board ruling highlights that clients have a right to be informed of and to consent to policy changes.
The ruling supported a FAIS Ombud’ determination to dismiss a complaint in the case of Sibaniso Phoshera v MUA Insurance Acceptances and KPC Brokers and Auto & General. But the Appeal Board supported aspects of the complainant’s version.
In this case, MUA Insurance Acceptances insured the complainant’s vehicle, and the policy was underwritten by Compass Insurance. Two years later, the complainant lodged a claim after an accident and found out to his surprise that his insurer had changed the underwriter to Auto & General. The complainant had not been made aware of the change.
Auto & General repudiated the claim, as the vehicle was not in a roadworthy condition as contemplated in the policy wording and prescribed by the National Road Traffic Act. The complaint was dismissed, as the tyres were worn and were “material to the cause of the loss”.
Arguments presented to the Appeal Board tried to justify that the complainant was not informed of the relevant changes to his policy. These arguments touched on the Policyholder Protection Rules (PRR), which permit the unilateral termination of binder agreements.
The Appeal Board pointed out that while unilateral termination may be permitted, this cannot automatically result in a new binder agreement without a client’s knowledge. Further, in terms of the PPR, a client is entitled to be notified of a change of underwriter, and that giving due notice is important to properly serve an insured’s interests. The advisor had failed to inform the complainant of the termination and creation of his policy contracts and related binder agreements.
The PPR requires an insurer to present evidence showing that a change in policy terms and conditions was communicated to a policyholder at least 30 days before an amendment comes into effect. An insurer must also demonstrate that a policyholder is furnished with an explanation of the principles of the relevant contract and information that enables a policyholder to make an informed decision on whether or not to continue with the cover.
It was held that the importance to inform a client is not simply to serve the purpose to notify, but rather to provide an opportunity for a client to exercise the choice to accept, refuse or alter a policy contract. This is in keeping not only with the PPR, but the Short Term Insurance Act the FAIS General Code of Conduct and the principles of Treating Customers Fairly.