Rejected claim shows devil is in the detail

Maureen Sharpe of Bergvliet who runs a travel company, Cape Seaside Excursions, had an insurance tussle with Oojah Travel Protection and MSC Cruises after a cruise she booked to Namibia for a group of 24 pensioners from various parts of the country, was cancelled because of bad weather.

The trip on MSC Sinfonia cost about R100 000 and though MSC Cruises refunded the money to the passengers, they would not pay the accommodation for the people who had to stay in Cape Town overnight.

It was, said Ms Sharpe, the insurance-speak that puzzled her. She said MSC staff told her each person would be getting a R750 refund “to make up for the disappointment of the cruise being cancelled”.

“The pensioners who had paid for the trip over several months were left stranded in Cape Town, except for four, who were flown back to Johannesburg, the same day. The others, though, would each have to pay R600 for their accommodation which MSC Cruises found for them. As we were under the impression from staff at MSC Cruises we were entitled to a R750 refund, I volunteered to advance the money to pay for the hotel until the issue was resolved,” said Ms Sharpe who submitted a claim to Oojah, MSC Cruises’s insurers, which was rejected.

However, the devil is in the detail which is why it is essential to read all the small print, not only on an insurance document, but on any contract you sign.

Ms Sharpe said MSC’s insurance states: “for people living more than 100km from point of departure R750 per adult to cover accommodation, meals, taxi/transfers. Any costs incurred up to the sum insured, however, they must provide Oojah with proof”.

There’s more but Oojah rejected the claim for R750 for each passenger although they offered an ex-gratia payment of R500 each. And Ms Sharpe did get the money, R12 000, she advanced for the overnight hotel accommodation.

“Please help us. I think this is a case of ‘bullshit baffles brains’,’’ said Ms Sharpe who told Oojah she was disappointed with their response, especially after MSC Cruises had told her each passenger was entitled to R750.

Joy van Aarde of Oojah said all cruise bookings require that you accept the terms and conditions of cover before you can finalise your booking. (So the passengers and Ms Sharpe must have read the document before they signed it).

Ms Van Aarde explained the “travel delay and cancellation benefits”.

Oojah would have paid the R750, if, among other things, there had been unforeseen illness, injury or death; a travel delay of more than 12 hours (the cruise was cancelled); a terrorist incident; pre-existing medical conditions or complications relating to pregnancy or childbirth, which, given the age of the passengers, was highly unlikely.

She told Ms Sharpe in an email, “As your cruise was cancelled by your cruise company, your policy does not cover the expenses you have claimed for. However, as a gesture of goodwill we offer an ex-gratia amount of R500 per family and a discount of 50% on any of our travel insurance policies for an international trip in the next 365 days from the date of the letter. Confirm via e-mail whether you accept our ex-gratia offer and provide a copy of your bank statement in order for us to finalise the payment to you.”

But Ms Sharpe was still unhappy.

When I asked Uriah Jansen, managing director of Oojah to explain the T’s and C’s in plain English, she sent me a copy of the letter she emailed to Ms Sharpe.

“We appreciate customers who take the time to provide us with all the information to assist us to make a decision on their claim. It must have been disappointing when the cruise was cancelled.

“I have reviewed the letter that was provided to all passengers by MSC Cruises. MSC explained that you are covered for R750 per person under the delay benefit of the insurance policy.

“Alternatively you may submit a claim under the cancellation benefit. They did not accept any liability on behalf of the insurance company. MSC sent this letter to all passengers that were affected by three cruises that were either delayed or cancelled.

“Your cruise was not delayed, it was cancelled by MSC Cruises who refunded the full cruise fare. Your claim for additional accommodation in Cape Town is not covered by your policy.

“You also do not qualify for the R750 delay benefit, as your cruise was not delayed, it was cancelled. Your claim has therefore been rejected in line with the terms and conditions of cover.

“We understand, however, that it was a group of pensioners, and therefore we offered an ex-gratia amount of R500 each.

“An ex-gratia offer is an offer of goodwill. We do not have to pay this amount to you, but based on the circumstances we felt that we wanted to at least offer some form of compensation.

“You do not have to accept the ex-gratia offer, in which case your claim remains rejected as the cancellation benefit does not provide cover for additional accommodation,” Ms Jansen said.

Ms Sharpe accepted the offer but asked for an extension of the deadline so she would have time to contact the 24 passengers and get the required documents including proof of identity, which was granted.