Page 10 - Claims Binders Mandates and Guidelines

5. GOODWILL PAYMENTS (EX GRATIA)
5.1 If a claim has been rejected and it has been decided in your offices to request a goodwill payment, the following is required:
5.1.3 Goodwill (ex-gratia) request form
The form, detailing the reasons for the request as well as any other documentation in support of the request, must be signed by a director or shareholder and forwarded to Hollard Insure together with any supporting documents.
NOTE: The reasons for granting the goodwill payment are confidential and are under no circumstances to be discussed with the claimant/claimant/or any outside party. It must further be noted that this payment is a ‘without prejudice payment’ and is not in terms of any existing policy and is made without any admission of liability.
5.2 Once you have been advised that the goodwill payment has been approved:
5.2.1 prepare a letter addressed to the claimant advising him of the goodwill payment as well as any conditions applicable thereto
5.2.2 obtain a signed goodwill payment form.
5.3 Please ensure that the claimant is aware that in the event of a total loss, payment will be made to the institution that has an insurable interest.
NOTE: A goodwill payment is made based on the condition that no admission of liability is accepted in terms of the policy. Hollard Insure cannot institute a recovery action, nor can Hollard Insure retain the salvage, unless it is specifically noted that this is a condition of payment and that the claimant has agreed to the goodwill payment in writing in the form of the signed goodwill payment form. Furthermore, it must be noted that a third party claim, liability claim, or any other liability claim cannot be entertained in the event of a goodwill payment being made to the claimant.
6. CHECKLISTS
Before any claim may be finalised, the following must be checked on claims for all classes of business. It is also important to remember that all checks or checklists should be visible on the claims file.
6.1 6.2 6.3
6.4 6.5
6.6 6.7
6.8
Always check the policy wording first in order to consider if the loss was caused by a claimant peril or event. Please also note and compare claims to all exclusions and terms and conditions of the policy.
Confirm that the premium for the appropriate month of cover has been paid. Has the premium been paid for the period of insurance in which the claim occurred?
Are we in receipt of a fully and properly completed claim form, completed by the claimant, signed and dated? Please note that only the claimant can make a claim against his policy and that the claim form is a legal document and requires full disclosure of how the loss occurred. Should the claim form not be complete we cannot process the claim. No employee may complete the claim form on behalf of a claimant under any circumstances. If the claimant is unable to complete the claim form, a legal entity or person can be appointed by him with the appropriate power of attorney to complete the claim on his/her behalf. If the claimant is deceased, an executor of his estate would be granted power of attorney.
Verify the police case numbers where applicable. Where an assessor is appointed, it would be required from the assessor to do this and to note our interest with the police.
Did the claimant select the appropriate cover to allow a valid claim on that section of the policy and is the sum claimant adequate? Is there an insurable interest?
Check whether the claim was submitted within the time limit allowed.
Consider if the claimant has had similar losses previously, either within the time of being insured through you or previous insurance. This will allow you to see if there may have been corrective underwriting or additional terms to apply to his contract of insurance.
Does the risk address correspond with the address given on the claim form?
General Procedures
Page | 8
Claims Binder Holders Mandates and Guidelines – V6: 2022