After eight long years, the Pretoria High Court on 16 October 2024 vindicated a begrieved motorist by ruling in his favour in a legal battle against his insurer.
Whilst driving his vehicle in 2016, a dog allegedly ran into the road and when the motorists swerved in an attempt to avoid the animal, they lost control of the vehicle and crashed it.
The motorist subsequently approached his insurer to claim for damages suffered, but his application was denied on three grounds.
As per Mtho Maphumulo, Senior Associate at legal firm Adams & Adams, the insurer repudiated the policyholder’s claim on the basis of:
- The policyholder drove at an excessive speed, showing reckless behaviour
- The policyholder allegedly misrepresented facts in his claim by stating he was avoiding a dog when he lost control of the vehicle, which the insurer argued constituted fraud
- The policyholder failed to comply with the policy’s “precautionary clause,” requiring him to take reasonable steps to prevent loss or damage
“Although both the policyholder and an eyewitness testified in court, the case hinged primarily on expert evidence from both parties,” said Maphumulo.
“The court ultimately ruled in favour of the policyholder, heavily criticising the insurer’s expert report for its deficiencies. The judgment concluded an almost eight-year dispute.”
A weak leg to stand on
The above case is a cautionary tale for insurers as it illustrates the deficiencies in relying solely on “expert evidence” to make a ruling on a client’s claim.
“Experts must not disregard the versions of the insured or eyewitnesses, especially where no objective evidence contradicts these accounts,” said Maphumulo.
“This is particularly critical when inspections occur after a significant time lapse.”
Ideally, insurers’ expert reports should be completed during the investigation stage of the claim. In this case, the insurer’s report was only prepared for the hearing, a practice that the court criticised.
Furthermore, he said that experts’ assumptions should be grounded in factual and physical evidence provided by the insured and any eyewitnesses.
“Eyewitness testimony should not be dismissed by experts without objective evidence to disprove it,” said Maphumulo.
Experts must also gather all relevant information, including locating eyewitnesses and verifying details with police officers when possible.
“Where SAPS reports are vague and evidence has degraded over time, experts’ conclusions should link closely with eyewitness accounts if these remain unrebutted by objective evidence,” said Maphumulo.
Should they lack sufficient evidence to substantiate assumptions, accident experts should make concessions.
“The judgment also shows that oversights in expert reports can reflect poorly on the expert and may even undermine the credibility of their evidence,” concludes Maphumulo.
“In preparing for a hearing, legal representatives should thoroughly review expert reports to ensure the evidence is of high quality and helpful to the court in reaching a fair decision.”
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