Page 11 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

General Procedures
6.5 Did the client select the appropriate cover to allow a valid claim on that section of the policy and is the sum insured adequate? Is there an insurable interest?
6.6 Check whether the claim was submitted within the time limit allowed.
6.7 Consider if the client has had similar losses previously, either within the time of being insured with you or previous insurance. This will allow you to see if there may have been corrective underwriting or additional terms to apply to his contract of insurance.
6.8 Does the risk address correspond with the address given on the claim form?
6.9 Check recent policy amendments.
6.10 Check policy endorsements and the client’s proposal form that may state specific terms and conditions.
6.11 Check previous claims history, and/or previous insurance.
6.12 Salvage: where applicable we require a full report from the repairer.
6.13 Do reinsurance and/or co-insurance contributions apply?
6.14 Are there any recovery prospects to consider on this matter?
6.15 Remember to always communicate corrective underwriting suggestions made by the loss adjuster and to adjust the policy with applicable no claims bonus (NCB) and/or endorsements after a claim where the need for this becomes apparent. For example: delete cover, upgrade cover, upgrade security, change address, change underwriting details on file. (Refer to the relevant underwriter.)
6.16 The second page of a property loss claim form often requires the client to state and list specifically what he is claiming for. Please ensure the client has completed this as well.
7. CLAIM PAYMENTS
7.1 The accounts department in your office is responsible for requisitioning the payments payable to VAT (Value-Added Tax)/non-VAT vendors.
7.1.1 If the invoice has VAT included in the amount, calculate the VAT implication and show the two amounts separately. VAT = 15/115 of total amount, for example on an amount of R228:
7.2 On receipt of a request for payment the following procedures should be followed:
7.2.1 On all invoices:
7.2.1.1 check that the amount on the invoice is as authorised
7.2.1.2 check that supporting documentation is attached
7.2.1.3 check that the release/discharge is attached; check that the release/discharge has been signed by the insured or the nominated representative
7.2.1.4 ensure that a valid tax invoice was received if the supplier is registered for VAT
7.2.1.5 if the above requirements are not met, advise the panel beater/supplier/assessor, giving details of the problem being experienced
7.2.1.6 for motor repair invoices, all additionals have to be checked and queried, the loss adjuster or assessor must sign this off as well
7.2.1.7 ensure the correct VAT numbers (if applicable) are on the invoices.
7.2.2 For repairs:
7.2.2.1 check to see that the documents are correct and in accordance with the letter of authorisation for that particular claim
7.2.2.2 check to see that the negotiated discount has been applied by the creditor according to the list of pre-arranged discounts
7.2.2.3 ensure that the invoice complies with the guidelines as in 7.2.1 above.
VAT = 228 X 15/115 Therefore VAT = R30
Full Binder Claims Mandates and Guidelines – V3: 2019 Page | 9