Page 5 - Claims Binders Mandates and Guidelines

General Procedures
1.28 Suspicion of driving under the influence of alcohol, or intoxicating drugs, fraudulent claims syndicates targeting insurers
1.29 Fraud
All claimants are to will treat claimants
1.29.1 Fraud can
1.29.1.1 1.29.1.2 1.29.1.3 1.29.1.4
be presumed innocent until proven guilty. Investigators, assessors and or loss adjusters with respect and treat each case based on merits.
present itself in a number of ways:
The fraudulent creation of a claim Overstatement of the claimed amount Misrepresentation to get cover
Insider fraud.
1.29.2 There are three stages at which fraud can enter the claims process:
1.29.2.1 1.29.2.2 1.29.2.3
The event
The quantification of the loss
The information in support of the claim.
• Please contact the Hollard Financial Crime Risk Management (FCRM) team, should you suspect any financial crime.
• The FCRM team provides all Hollard Insure and binder holders with strategic fraud risk management, prevention, detection, investigation, remediation as well as Anti-Money Laundering (AML) support.
• All matters relating to fraud, financial misconduct and AML for Hollard Insure FCRM must be sent to HollardInsureFCRM@hollard.co.za.
• You may also report suspicions of financial crime & fraud, non-compliance & unethical behaviour to the Hollard Tip-offs toll-free line on 0801 516 170, or by sending an email to Hollard@tip-offs.com or Fraud@hollard.co.za.
2. CLAIMS TO BE REPORTED TO HOLLARD INSURE
Claims will be administered by you according to the delegated authority and mandate agreement. As soon as the claim is above the agreed upon mandate (inclusive of VAT and prior to excess deduction, recovery, or salvage money), or is specified as out-of-mandate e.g. Personal Accident, Catastrophe, etc. the claim must be reported to Hollard Insure.
2.1 Claims exceeding the mandate
Claims that exceed the claims mandate may therefore NOT be authorised by your office without Hollard Insure’s authorisation. Authorisation will be provided by the Hollard Insure claims specialist once all the claim documentation has been received and reviewed.
2.2 Claims outside mandate
The following are claims that are considered to be outside of your claims mandate and should be referred to Hollard Insure as soon as you become aware of these types of claims. You cannot proceed with the claim until you have received authorisation to proceed by Hollard Insure.
2.2.1 All claims over the value of the agreed mandate (as stated above)
2.2.2 All fire claims, irrespective of the quantum, are to be referred to Hollard Insure prior to any loss adjusters/assessors being appointed
2.2.3 Any claims where drunken driving is suspected must be referred to Hollard Insure immediately
2.2.4 Any claims where fraud is suspected must be referred to Hollard Insure immediately
2.2.5 Late notification – claims older than 45 (forty-five) days
2.2.6 Liability (except General Motor)
2.2.7 Any staff claim (including Hollard Insure staff)
2.2.8 Goodwill (ex-gratia) claims
Claims Binder Holders Mandates and Guidelines – V6: 2022
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