In an October 2024 judgement, the Pretoria High Court examined the rejection of an insurance claim following a motor vehicle accident. On 26 December 2016, the claimant was driving his insured sports car when he collided with a wall. He filed a claim with his insurer, which was rejected on the grounds that he had provided dishonest information about the speed he was driving, how the accident occurred, and alleged failure to take reasonable care to prevent the accident because he was driving at an excessive speed.

The Insurer relied on the following section of the policy stated:

  1. “MiWay will not pay me for a claim when I, … deliberately caused the loss, damage or injury; and
  2. If I or anyone acting on my behalf submits a claim or any information or documentation relating to any claim that is in any way fraudulent, dishonest or inflated, all benefits under this policy in respect of such claim will not be paid;
  3. In order to have continuous cover and a valid claim, I must:…use all reasonable care and take all reasonable steps, with the same degree of carefulness which can be expected from the reasonable man on the street, to prevent or minimise loss, damage, death, injury or liability;”

At trial, the claimant testified that he was driving between 45-50 km/h when a dog suddenly entered his path, leaving him no time to react. To avoid hitting the dog, he swerved and impacted the kerb, losing control of the vehicle and collied with the wall. He emphasised that he was familiar with the road, the conditions were clear, and it was light enough to see without streetlights.

The claimant’s expert noted that the damage to the vehicle was consistent with an impact speed between 50 km/h and 60 km/h, although pinpointing an exact speed was difficult.

The insurer’s expert argued that the claimant was driving at an excessive speed of 90-100 km/h and had applied full braking prior to the collision. His calculations were based on these assumptions as well as that there had been no dog, and so the driver had not swerved the vehicle. However, under cross-examination, the expert:

  • Agreed that the damage was possible from an impact speed as low as 50 km/h.
  • Accepted that there were no physical markings indicating 100% braking on the road.
  • Acknowledged that on the driver’s version, calculations for the estimated speed would be substantially lower.

The court found the insurer’s expert report flawed due to the assumptions, stating, “There was no basis for [the expert’s] rejection of the driver’s version” The judge remarked, “The process cannot … be complete without [the claimant’s] version of how the accident occurred especially where the process of reconstruction is done after a lapse of a considerable period.” The insurer’s expert was faulted for not consulting with the claimant to obtain necessary information, which could have provided valuable context to the accident reconstruction.

Interpreting the policy provisions, the court highlighted that certain of the terms in the policy required intent or fraud, neither of which were proven. Regarding the allegation of deliberate causing of loss, the court noted that “The legal implication of this condition is that if [the claimant] was speeding intentionally, it may indicate reckless behaviour that could establish intent.” However, the evidence did not support such a conclusion.

Looking to paragraph c, the court found that “The legal implication of this condition is that driving at excessive speed may demonstrate a failure to exercise reasonable care, thereby establishing negligence.” It was for the claimant, so the court held, to “demonstrate that he was not driving at an excessive speed and that he acted reasonably on the day of the accident” at which point it became the insurers burden to prove that the claimant’s “actions directly contributed to the accident and that he failed to meet the standard of care expected of him in that situation.” The court concluded that the insurer had not proved that the claimant had failed to meet the expected standard of care.

On the allegation of providing dishonest information, the court stated, “From proven facts and the evidence before me there is no evidence that suggest that [the claimant] supplied the insurer with dishonest information relating to the speed he was driving, and how the accident occurred.”

The court concluded that the insurer had “failed to meet the threshold required in law to sustain a repudiation of [the] claim and failed to prove a breach of the insurance agreement that would entitle it to repudiate the claim.”

Mthethwa v MiWay Insurance Limited (84333/2017) [2024] ZAGPPHC 1095 (16 October 2024)