Legal Question in Criminal Law in South Africa

My insurance company hasn't directly accused me of fraud but have suggested that I am been dishonest in my list of items on the claim. I cannot produce the require proof of ownership for these items as the were almost all digital invoices - in many cases, I had paid cash for an item, so there is no record on my bank statement.

I have since written a letter removing these contentious items from the claim, at the urging if the assesor (the same one inferring fraud and criminal action)...

They are either going to pay for items with proof of ownership, repudiate the claim, reject the claim and cancel my policy( seems to me that this is where it is headed) or, as was made clear to me: reject, cancel and file charges of fraud against me.

The last option is what scares me the most - yes, I should have kept better records but is that enough for me to go to jail for fraud?

Any advice would be greatly appreciated!


Asked on 5/07/14, 11:23 am

1 Answer from Attorneys
Sam Jackson

Even if the insurance company puts its threats into action it will still be a long way to go before there can even be talk of a criminal prosecution. Firstly, the police will have to investigate, then the docket is sent to the prosecutor for a decision on whether or not to prosecute. Only then, if a decision is made to prosecute will charges be brought against you.

If charges are formally brought against you, the state still bears the onus of proving that you committed fraud, which is not as simple as the assessor made it sound. In my view, it is more likely that the assessor was trying to intimidate you into not pursuing your claim. Instead of withdrawing your claim, one can take the view that when you took out your policy, the insurance company was happy to provide the cover and take your monthly premiums, but now that its is time to pay up they are looking for excuses.

In light of this, you may actually have a dispute to refer to the ombudsman for short term insurance.

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Answered on 5/08/14, 1:26 pm


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