Here is what Jubilee Allianz Insurance said; A claim was reported to us on 28/12/2021 relating to an accident which happened on 7/1/2022.
The motor private policy seeks to indemnify the insured in the event of a fortuitous loss or damage to the vehicle or its accessories or spare parts while in or on the vehicle.
According to the insured, the insured driver was driving alone at around 2130hrs along Eldama Ravine-Eldoret Road heading to his rural home in Kaptagat. One reaching Kamwosor area, where the road was under construction, he encountered an unknown oncoming vehicle which encroached into his lawful lane while avoiding hitting a pothole.
The insured driver swerved to the left side of the road to avoid head-on collision, but lost control of the vehicle, veered off road and landed into a ditch. The vehicle suffered underneath damages (sump guard), dented front bumper, oil leakages, cracked windscreen and airbags deployed. The driver was not injured.
The insured driver reported the matter to Kaptagat police station and police officers visited the scene.
The motor assessor quantified the cost of restoring the vehicle to its pre-accident condition to be kshs.469,626/= but raised concerns on the consistency of the damage. We appointed Leon private investigators to validate the claim, confirm the circumstances and consistency of the damages.
The assessor and the investigator noted the following inconsistencies;
- The damages on the windscreen could not have been caused by rapturing of the dashboard airbag. The airbag was deployed halfway, and it couldn’t have reached the windscreen. In addition, the windscreen has three points of impact originating from outside.
- The circumstance of the accident is that the driver lost control while trying to avoid head on collision. This caused the vehicle to veer off the road into the ditch where it had underneath damages. Considering the clearance distance of insured vehicle from the ground level and the distance from the front bumper to the engine sump, the impact that caused damages on the engine sump and the engine cradle could have damaged the front bumper first. The underneath damages appear to have been self, selectively inflicted on the vehicle. It is not because of the vehicle landing into the ditch with stones.
- The diagnosis port point was also noted open, and the front bumper had old, pre-accident scratches not related to the accident.
- The claim was declined due to the above inconsistencies. Attached please find the technical findings report.
The Cofek questions that Jubilee Allianz Insurance could not answer;
Thank you for the kind response. As a preliminary question, and assuming your investigator’s ‘technical report’ is real, verifiable and believable – where do you as an insurer get the legal and or such other powers to have to conclude that ‘the claim is declined due to inconsistencies”?
Hope you noted the part where your own (he is not independent) investigator says he couldn’t ascertain the road condition and that the accident scene has been interfered?
He never said it is the insured who damaged the same. Again, the conclusions from your investigator are very generic. What relationship and or experience does he have in Volvo vehicles and percent rapturing, or failure, of airbags against impact?
Is he an authorized dealer of Volvo vehicles and or has undertaken such training in the mechanics? Again, could he have based his conclusions on a wrong premise? Did you as the insurer have some form of abundance of caution dis(agreeing) with his version? Or is it final?
Does declining the claim mean you assume zero responsibility? Can we access the original photographs from the investigator, the camera model/age and respective angles he applied? Please action asap.
Incidentally, the cover was issued as a group one for Kenya Power & Lighting Company for vehicle number KDC 994M
We hope you are aware of the provisions of Section 7 of the Consumer Protection Act, 2012 on ambiguities and why any Court would rule in favour of the consumer (the insured). Again, Article 46(1)(b) requires full and proper information. We hope you can respond to the above questions within 24 hours.
We also hope you will find the Alternative Dispute Resolution cost-effective as compared to a Court process and potential negative public exposure.
Having refused to cooperate, Cofek has instructed its’ lawyers to prosecute Jubilee Allianz Insurance of Kenya.