Page 10 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

4.4 Inform the claimant of the procedures to be followed, depending on the claim type, i.e.:
4.4.1 Accident own damage
4.4.2 Stolen vehicle
4.4.3 Radio theft
4.4.4 Windscreen/glass damage.
NOTE: It is the responsibility of the broker to ensure that costs are minimised and that the client’s discomfort is kept to a minimum. If in doubt about any aspect, refer to Hollard.
5. EX GRATIA PAYMENTS
5.1 If a claim has been rejected and it has been decided in your offices to request an ex gratia payment, the following is required:
5.1.1 Ex gratia request form
The form, detailing the reasons for the request as well as any other documentation in support of the request, must be signed by a director or shareholder and forwarded to Hollard together with any supporting documents.
NOTE: The reasons for granting the ex gratia payment are confidential and are under no circumstances to be discussed with the insured/claimant/or any outside party. It must further be noted that this payment is a ‘without prejudice payment’ and is not in terms of any existing policy, and is made without any admission of liability.
5.2 Once you have been advised that the ex gratia payment has been approved:
5.2.1 prepare a letter addressed to the insured advising him of the ex gratia payment as well as any conditions applicable thereto
5.2.2 obtain a signed ex gratia agreement of loss.
5.3 Please ensure that the insured is aware that in the event of a total loss, payment will be made to the institution that has an insurable interest.
NOTE: An ex gratia payment is made based on the condition that no admission of liability is accepted in terms of the policy. Hollard Insure cannot institute a recovery action, nor can Hollard Insure retain the salvage, unless it is specifically noted that this a condition of payment, and that the insured has agreed to the ex gratia payment in writing in the form of the signed ex gratia agreement of loss. Furthermore, it must be noted that a third party claim, liability claim or any other liability claim cannot be entertained in the event of an ex gratia payment being made to the insured.
6. CHECKLISTS
Before any claim may be finalised, the following must be checked on claims for all classes of business. It is also important to remember that all checks or checklists should be visible on the claims file.
6.1 6.2 6.3
6.4
Always check the policy wording first in order to consider if the loss was caused by an insured peril or event. Please also note and compare claims to all exclusions and terms and conditions of the policy.
Confirm that the premium for the appropriate month of cover has been paid. Has the premium been paid for the period of insurance in which the claim occurred?
Are we in receipt of a fully and properly completed claim form, which has been completed by the insured, signed and dated. Please note that only the insured can make a claim against his policy and that the claim form is a legal document which requires full disclosure of how the loss occurred. Should the claim form not be complete we cannot process the claim. No employee may complete a claim form on behalf of an insured under any circumstances. If the insured is unable to complete the claim form a legal entity or person can be appointed by him with the appropriate power of attorney to complete the claim on the client’s behalf. If the client is deceased, an executor of his estate would be granted power of attorney.
Verify the police case numbers where applicable. Where an assessor is appointed it would be required from the assessor to do this and to note our interest with the police.
General Procedures
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Full Binder Claims Mandates and Guidelines – V3: 2019