Page 39 - Claims Binders Mandates and Guidelines

Non-motor Claims Procedures
It should also be noted that for straightforward building/plumbing claims up to a value of R50 000 (fifty thousand rands), an assessor/loss adjuster does not need to be appointed. Building contractors or plumbers can be appointed directly. If it is a fire claim, a loss adjuster must be appointed.
2.2 Loss adjuster’s responsibilities
2.2.1 All reports are to be addressed to Hollard Insure care of the binder holder and sent to the binder holder.
2.2.2 The loss adjuster must conform to a code of conduct and ethics laid down by the Institute of Loss Adjusters (ILA) and have professional indemnity insurance in place.
2.2.3 The loss adjuster may not conduct any other form of conflicting business.
2.2.4 Conflict in interpretation of policy wordings – the loss adjuster must consult with the principal and present his own views. He must, however, follow the principal’s guidelines and instructions and not venture into offering legal opinions.
2.2.5 The acceptance of affidavits as proof of ownership may not be accepted without consulting principals.
2.2.6 Where the loss adjuster suspects fraud of any nature, he must immediately contact Hollard Insure concerning the matter before drafting any report. The report needs to be forwarded to Hollard Insure immediately, as the insurer may wish to take legal advice.
2.3 Binder holder’s responsibilities
2.3.1 Clear written mandates and instructions to be given.
2.3.2 Full details of cover to be given – a copy of the policy schedule, endorsement, wording, and proposal forms.
2.3.3 Be reasonable – often the loss adjuster has to act speedily with limited information to prevent further loss or damage, for example, a fire claim.
2.3.4 Attempt to estimate the assessor’s fee at the time of appointment.
NB: All reports must be without prejudice.
3. MINIMUM INFORMATION/REQUIREMENTS FOR SMALL COMMERCIAL BUSINESS INTERRUPTION CLAIMS
3.1 Manufacturing type business
3.1.1 Specifications of the plant and machinery which are the subject of the loss should include the following:
3.1.1.1 The claimant’s formulated claim in terms of the policy.
3.1.1.2 Make, model, name, and description of the machinery.
3.1.1.3 Maximum capacity or plate speed of the plant and machinery.
3.1.1.4 The bottle neck in the claimant’s manufacturing environment.
3.1.1.5 Confirmation of whether the claimant manufactures to order or stock.
3.1.1.6 A brief description of the business and operations, including claimants and suppliers together with major competitors (if these are not clear from well-known companies).
3.1.1.7 The monthly stock figures (volume, quantity, and value) for the preceding 12 (twelve) months before the incident and up to 1 (one) or 2 (two) months post the end of the interruption period.
3.1.1.8 We would request production figures for ideally 24 (twenty-four) months prior to the incident and from the date of the incident through to 2 (two) months after the interruption period.
3.1.1.9 A description providing as much detail as possible surrounding the circumstances of the loss.
3.1.1.10 A description in as much detail as possible on the cause of the loss in as far as this is known to the claimant.
Claims Binder Holders Mandates and Guidelines – V6: 2022 Page | 37