Page 13 - Claims Binders Mandates and Guidelines

General Procedures
7.3.6.3 Process
• Claimants must submit a formal complaint, supported with proof that a financial loss was suffered, and that the payment was not paid within 10 (ten) days after signing the AOL.
• The claimant's complaint must be logged via the complaint’s mechanism.
• Claims must investigate whether the payment delay is as a result of a delay caused by the insurer or the claimant.
• In the event of a failure by the insurer, interest payable for late payments must be considered and signed off by the Regional or Claims manager, with a full synopsis that led to the failure.
• Mandated managers’ authorisation of the payment is to reflect on the claim.
• Should it be decided that the interest for late payment will be paid, an offer of settlement will be presented to the claimant.
• Upon the claimant accepting the interest offer, the file should be diarised for 3 (three) business days to follow up again on the payment.
• A manual register is to be kept to keep record of interest paid on late payments.
• Detailed notes are to be placed on the claims systems.
• Where appropriate, action must be taken to try and eliminate any future failure of the same nature.
• The claim is closed once proof of payment is sent to the claimant.
8. CLAIM REJECTION/VOIDANCE
• Rejection: a claim is rejected due to non-adherence to policy conditions, or the incident is not covered under the policy perils.
• Voidance: the policy is voided from inception or renewal due to misrepresentation or false declaration at underwriting stage.
8.1 A decision to accept, reject or void a claim, irrespective of whether in full or in part, must be taken within a reasonable period of time.
8.2 As per the PPR17.6.2., once a decision is taken, a claimant must be notified within 10 (ten) days of the decision.
8.2.1 The 10 (ten) days include both the Hollard Insure and binder holder timeline, and the letter must reach the claimant within 10 (ten)-days of the date of the letter.
8.3 On receipt of information where the claim should be considered for rejection, the file has to be referred to Hollard Insure without delay for consideration.
8.3.1 If the rejection is not justified, Hollard Insure will liaise and provide reasons and comments for the decision.
8.3.2 If further information is required to assist with the decision to be made, Hollard Insure will request the required documentation and a decision will then be made regarding the validity of the claim.
8.3.3 If the rejection is justified, Hollard Insure will draw up a rejection letter based on the standard rejection letter template.
NOTE: It is of utmost importance that the grounds of rejection are supported by the necessary documents/evidence (for example, where a claimant has made a verbal statement, this must be supported by a written statement to the same effect).
8.4 A copy of the signed letter of rejection will be sent by Hollard Insure to you, the claimant binder holder/ representative. This is aligned to the PPR requirements. It is the responsibility of the claimant's binder holder/representative to ensure that the claimant is advised of a rejection of a claim and the reason for rejection, within 10 (ten) days of the decision being made. You, as the claimant's binder holder/ representative, must discuss the escalation process with the claimant as to how to complain, should the
Claims Binder Holders Mandates and Guidelines – V6: 2022 Page | 11