Page 8 - Claims Binders Mandates and Guidelines

The claims handler, after completing the steps below, must check the file and establish what type of claim is being dealt with and become familiar with the procedures which are to be followed for the type of claim.
3.4.4 Provision of 15 (fifteen) days' grace period is allowed for late payments of premiums. In the case of a monthly policy, the grace period will apply from the second month of inception (PPR Rule 15).
3.4.5 When valid claims are received during the grace period of 15 (fifteen) days, the unpaid premium may be debited/reduced from the claim settlement where applicable (PPR Rule 17.12.1). Before final claims settlement, ensure checks are done to confirm if any premiums are outstanding.
3.4.6 Ensure that documentation for proof of cover and premium confirmation is on file for the specific date of loss for which the claim is submitted.
3.4.7 Verify that the claimant has the appropriate cover for the type of claim submitted. Evidence should be made available on request.
3.4.8 Ensure that all the required documents are on record. If any documents are missing, take steps to obtain them, for example request documents by email and keep the email request on record.
3.5 Check that the necessary steps have been instituted to have the claim processed as soon as possible (assessor/investigator appointed, etc.).
3.6 Check the claims history of the claimant to:
3.6.1 cross-check information on the proposal and verify information such as disclosures made by the claimant on the proposal related to the risk which the claim pertains to; check previous claims history; check previous insurance history disclosed
3.6.2 determine whether there is a possible trend in the claimant’s claim submission
3.6.3 establish whether any previous claim(s), if any, can assist with the handling of the current claim (for example on a stolen vehicle claim; refer to the assessor’s report on previous own damage claim for details on the condition of the vehicle, alarm/mobiliser, radio, etc.)
3.6.4 advise Underwriting if a claimant is an undesirable risk and obtain instruction from Hollard Insure prior to any action taken.
3.7 If the claim form is incomplete, contact the claimant and arrange for the completion thereof. Under no circumstances may you alter or complete the claim form. Supplement missing information on a separate sheet.
3.8 Check the claims information and verify the following on the administration system:
3.8.1 the estimates are correct and update same if necessary
3.8.2 the claim type codes are correct and update same if necessary
3.8.3 the excess has been calculated correctly and correct same if necessary
3.8.4 the claim has been registered on the claims system and all the required information is completed. Update same if necessary.
4. CLIENT HANDLER RESPONSIBILITIES
4.1
Advise/inform the claimant:
4.1.1
that the claim form must be completed in full and to verify that all the relevant information is supplied, i.e.:
4.1.1.1 name of the police station where the case was reported, as well as the case number and the name of the officer who took down the details, names and the addresses of any witnesses
4.1.1.2 names and addresses of the driver(s) and registration numbers of any other vehicle(s) involved (if any)
4.1.1.3 name of the company and company's representative if the vehicle is a company vehicle and registered as such
General Procedures
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Claims Binder Holders Mandates and Guidelines – V6: 2022