The Story
In a case that highlights the importance of independent evaluation and fair mediation, a couple’s insurance claim was initially rejected due to a disputed assessment of their vehicle’s condition. The dispute centered around a motorhome that had been stationary in their driveway when a third-party driver lost control of their car in 2014 and collided with it, causing visible damage to the side panel.
Following the incident, the complainants filed a claim with their motorhome insurance provider, expecting that the repair costs would be covered under their policy. However, the insurance company appointed a local garage, referred to as Garage A, to assess the damage. The garage’s expert concluded that the motorhome was not in a roadworthy condition at the time of the accident, citing concerns over the state of the chassis. Based on this finding, the insurer invoked a clause in the policy that voids coverage if the vehicle is not maintained in a roadworthy state, and denied the claim.
Feeling the decision was unfair and unrelated to the actual cause of damage, the complainants sought clarification. The insurance company advised them to obtain an official roadworthiness confirmation from the local Department of Motor Vehicles (DMV). However, when the complainants contacted the DMV, they were informed that such assessments are not provided to the public, leaving them with no immediate recourse.
Frustrated and facing a costly repair, the complainants escalated the matter to an independent insurance ombudsman. The ombudsman reviewed the case and noted that the vehicle was legally parked and not being driven at the time of the incident. They also highlighted that the damage resulted from an external impact unrelated to the motorhome's mechanical state. More importantly, a second opinion from an independent expert found no serious chassis issues and confirmed that the vehicle could reasonably be considered roadworthy prior to the accident.
Based on this evidence, the ombudsman determined that the insurance company had made an incorrect decision and recommended a mediated resolution. The insurer agreed to reassess the claim and ultimately covered the repair costs in full.
This case underscores the need for claimants to challenge decisions they believe to be unfair and to seek independent assessments when there is a dispute. It also serves as a reminder for insurers to ensure that expert evaluations are both relevant and unbiased, especially when denying claims that could significantly impact policyholders.
