As South Africa is reeling from a series of flooding, form the notorious KZN floods to the intense rains that have been relentlessly falling in several provinces, Drivers might be unaware of the implications of driving into rainwater, when this results in damages.
If you look at the Ombudsman for Short-Term Insurance’s Briefcase from March 2016, the following Case Study should be seen as a warning for those thinking it’s okay to drive through deep pools of water.
The Case Study reads as follows:
The insured reported that his vehicle was damaged after he drove it through a flooded road. He said that the vehicle stopped immediately and would not start or shift gears.
A service provider appointed by the insurer stated that the vehicle suffered damage to the engine as a result of ‘water being sucked into the engine when the insured drove over water on the road’.
The service provider found that the air cleaner was wet, and the intercooler was full of water. A compression test revealed that the connecting rods were bent due to a hydraulic lock caused by water entry into the cylinders.
The insurer concluded that the damage was not covered because the vehicle only sustained damage to the engine. The insurer quoted the following exclusion from the policy wording in its rejection letter:
- WHAT YOUR VEHICLE COVER EXCLUDES:
11.1 The Insurer does not compensate under this Policy Section for claims for any
of the below points.
- n) Damage to the engine (or directly connected parts) unless:
- some other part of the vehicle is damaged at the same time; or
- the damage is caused upon impact during an accident.
The Insured Challenges the Rejection of the Claim
The insured argued that the claim should be settled on the ground that the policy covered damage caused by natural disasters.
The Insurer’s Response
The insurer maintained that, although an insured peril operated, the above policy exclusion applied in the circumstances. The insurer submitted that no other part of the vehicle was damaged at the same time as the engine, or as a result of impact during an accident.
OSTI’S Finding
OSTI considered the definition of the words “impact” and “accident”. The word “accident” is primarily intended to include an unintentional, unexpected event of a fortuitous nature.
OSTI found that a fortuitous event had occurred which fell within the definition of an “accident”. Accordingly, OSTI found that the insured’s loss fell within the cover provided by the policy and recommended that the insurer settle the claim.
The Insurer’s Response to OSTI’S Recommendation
The insurer disagreed with the re-commendation and requested a review. The insurer maintained that the damage to the engine fell within a policy exclusion. The insurer argued that, while an accident may have occurred, there was no evidence to support a conclusion that the accident was due to impact, as required by the policy.
The final outcome
The Escalation Committee, comprised of the Ombudsman, CEO, and four Senior Assistant Ombudsmen, agreed that, based on the service provider’s report, the first criteria for cover had not been met in that “some other part of the vehicle” was not damaged at the same time as the engine.
OSTI’s previous findings concentrated on the second criterion, namely, that the damage is caused during an accident, which the insurer conceded had occurred.
The issue for determination was whether the engine damage was caused “upon impact”.
The word “impact” was not defined in the policy. The Oxford English Dictionary defines “impact” as follows: “the action of one object coming forcibly into contact with another”.
Dictionary.com provided the following definitions:
noun
- the act of one body, object, etc, striking another; collision.
- the force with which one thing hits another or with which two objects collide.
- the impression made by an idea, cultural movement, social group, etc: the impact of the Renaissance on Medieval Europe.
verb
- to drive or press (an object) firmly into (another object, thing, etc) or (of two objects) to be driven or pressed firmly together.
- to have an impact or strong effect (on)”.
The Cambridge Dictionary defines “impact” as “the force or action of one object hitting another”.
Considering the above definitions, OSTI found that the engine damage in this case did not occur upon the vehicle coming into contact with the pool of water. According to the service provider’s findings, the damage was caused by water being sucked into the engine, not the impact.
On a proper interpretation of the policy, the damage which caused the engine to seize did not occur upon impact during an accident, and as such, was not covered. The insurer’s decision to reject the claim was upheld, based on the policy exclusion.