Page 19 - Claims Binders Mandates and Guidelines

General Procedures
16. CLAIMS RESERVES/ESTIMATES
The following claims reserve/estimate guideline serve can be used by binder holders;
16.1 The initial estimate at claim registration must be a realistic estimation of the loss.
16.2 Estimates must be adjusted within 5 (five) business days of quantum being confirmed and any changes thereafter.
16.3 Once the signed agreement of loss (AOL) or invoice is received, the estimate must be verified against this document.
16.4 Invoices that are greater than the authorised amount must be referred back to the department that quantified the claim (assessor/loss adjuster).
16.5 Initial car hire estimate is to be captured at R4 500 (four thousand five hundred rand).
16.6 At appointment of an assessor/loss adjuster/investigator/specialist/service provider, an estimate must be raised for their fees.
16.7 For stolen or written-off vehicles the estimate must be the sum insured or retail value (whichever is the lesser). Verify if there are extras specified on the policy. If so, amend the estimate to include these accordingly.
16.8 Estimates must be captured under the correct sections noted on the system, for example: car hire, towing, assessing fees.
16.9 Estimates must be nullified before closing the file.
16.10 Estimates must be nullified if the claim is rejected.
16.11 Estimates may not be reduced to manipulate any claims process.
16.12 The SAIA code of conduct to be considered in estimate activities.
16.13 Cover: Determine whether the customer is entitled to an indemnity under the insurance contract and if so, the extent of the indemnity. Remember to take into account deductibles, excess, first amount payable.
16.14 Interest: An allowance for interest must be made should interest be payable in terms of the Prescribed Rate of Interest Act (15.5%).
16.15 Claims that are clearly not covered by the insurance policy should have a zero estimate (R0).
16.16 Rejected claims/summons issued: In this case it is necessary to reserve for our legal costs only. However, if there is a reason to believe that the rejection will be overturned, then the reserve needs to include the probable total cost of the claim, including legal costs for Hollard Insure as well as the other party.
16.17 Salvage recovery: The estimate should not include a future possible salvage recovery.
16.18 Co-insurance policies: The estimate should reflect Hollard Insure’s co-insurance portion.
16.19 SASRIA: No estimate will be raised until such a time that it is decided that SASRIA is not responding and that the policy needs to respond.
16.20 Excess: Excesses can be communicated to the insured during registration of the claim but the registration estimates raised should always be gross and therefore inclusive of the excess amount. The net estimate (gross excess minus the excess) should always be applied once the claim is quantified and authorised. Reference should always be made to the schedule of insurance as the final authority as to what the excess amount or percentage deductible should be.
Claims Binder Holders Mandates and Guidelines – V6: 2022 Page | 17