Page 18 - Claims Binders Mandates and Guidelines

14.1.5.1 14.1.5.2 14.1.5.3
14.1.5.4
14.1.5.5
delay in finalizing an assessing-, loss adjustment- or investigation report;
delay in the sourcing of replacement parts during a vehicle accident damage repair;
delay in the upliftment and release of a stolen and recovered vehicle due to SAPS process;
delay in sourcing of replacement items due to non-availability;
or any other reason for a delay in the claim timeline.
14.1.6 the decision (i.e. indemnification and settlement method, rejection or voidance) in response to the claim within 10 (ten) days of the decision being made.
14.1.7 payments must be made within 10 (ten) days of the quantum being agreed. If the claimant indicates financial hardship, the claim must be fast-tracked.
Communications to claimants must be transparent, visible, accessible and in plain language. The type and reason for information must be clear and relevant to the claim. Time limitations, excesses and the responsibilities of the claimant must be clearly communicated throughout the life cycle of the policy and claims process.
15. CLAIMS COMPLAINTS/DISPUTE RESOLUTION
In accordance with the STIA PPR and SAIA Code of Conduct, the binder holder must:
15.1 Document and make available a dispute resolution and complaints escalation process that provides for:
• a contact person for complaints
• complaints to be acknowledged
• complaints to be logged into a system
• an outcome to be recorded, and
• formal communication to the claimant.
15.2 The process must be monitored and must not impose an unreasonable burden to the claimants.
15.3 Progress must be communicated to the claimant, at least every 10 (ten) days.
15.4 If further information is required from the claimant to resolve the dispute, it must be communicated within 15 (fifteen) days.
15.5 The dispute resolution/complaint outcome must be formally communicated to the claimant within 21 (twenty-one) days.
15.6 Complaints must formally be logged via the Hollard Response system by submitting an e-mail in writing to hollardinsurecomplaints@hollard.co.za.
General Procedures
14. CLAIMS COMMUNICATION
In accordance with the STIA PPR, the binder holder must only require from a claimant information or documentation which is essential to the assessment of the claim.
14.1 Claimants must be kept adequately informed of:
14.1.1 the progress of their claim (at least once a week)
14.1.2 respond to routine requests within 5 (five) days
14.1.3 the indicative timelines by when a claim will be finalized. In this regard, Hollard aims to abide by the timelines highlighted in the Claims Process Standard Turn-around Times TAT’s, located under ‘Claims’ on the Binder Library. The Binder Holders are required to strive towards the same standard TAT’s when processing claims.
14.1.4 causes of any delay in the finalisation of a claim
14.1.5 the circumstances under which any timeframes during the management of a claim may be extended, reasons for the delay and revised timelines, including but not limited to:
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Claims Binder Holders Mandates and Guidelines – V6: 2022