Personal Accident – Late notification

Background

X Golf Club (Policyholder) had purchased a Daily Golfer Policy for their registered members and Insured is one of their members. The Insured met with an accident on 17/2/2016 at the Policyholder’s golf club. The Insured then filed a claim under the Policy for accidental medical expenses in relation to his “Fracture of Right Fibula”.

The claim was repudiated by the Insurer on the ground that the Insured did not notify the Insurer within the stipulated time frame.

The Insurer had referred to the provision provided under the General Condition of the Policy which states:

“19. On the happening of any occurrence likely to give rise to a claim under this Policy, you or your legal representative must give Us written notice as soon as possible and, in any event, within thirty (30) days after the date of occurrence.”

 

Investigation and Findings

The Case Manager observed that the Insurer’s decision was based on the following:

  1. the Insured did not make any police report. Hence, they were unable to obtain any information about the accident ;
  2. the accident was not informed to the Policyholder (X Golf Club) within the same day ; and
  3. the claim was only notified to the Policyholder on 13/5/2016 which is about three months from the date of accident, i.e.17/2/2016.

 

Nevertheless, the Insured had explained that he was seen by the X Golf Club official after his injury on 17/2/2016. He also informed that the official had advised him to see the doctor immediately and he went to Hospital Z on the same day. Due to the injury, the Insured was on medical leave and was unable to walk without support and drive his vehicle. As such, he only went to the X Golf Club to hand in his claim documents when he was able to drive.

The Case Manager requested the Insured to furnish us with a clarification letter from the official person who attended to him at X Golf Club on the accident day.

The Insured furnished us with a clarification letter from the supervisor of the club wherein the supervisor had confirmed that on 17 February 2016, he attended the Insured after the accident. He further stated that he had advised the Insured to consult the doctor and advised the Assured to go to the nearest Hospital Z as the Insured was in pain. He also confirmed that he could not get a report from the Insured as the Insured had left for medical treatment immediately.

The Case Manager was of the view that as the supervisor-in-charge is from the X Golf Club (Policyholder), the Policyholder was aware of the accidental event that happened on 17/2/2016. However, as the Insured had left the place without any report, the supervisor on behalf of the Policyholder should have taken the necessary step to notify the Insurer as per the General Conditions 19 stated in the policy. As they had failed to do so, the Case Manager opined that the Insured should not be penalized for the late notification.

 

Settlement

The Insurer reviewed the case and agreed to settle the claim.