Page 13 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

General Procedures
You as the broker may remove the estimates once the claim is rejected. The claim may be finalised after the prescriptive period. For personal lines business, and business subjected to PPR, the minimum period prescribed under the PPR for representation to the insurer is 90 (ninety) days after the decision has been made. The 90 (ninety) days may not be included in any time-barring period contained in the policy for institution of legal action. The insured can make representation to, or lodge a complaint with the insurer within 90 (ninety) days. Where the dispute remains unresolved, the policyholder then needs to institute legal action within the time period stipulated in the policy wording. This is usually a period of 180 (one hundred and eighty) days. Most policies therefore have a time bar period of 270 (two hundred and seventy) days in total.
If the commercial policy is governed by the PPR (this is where the insured company has a turn over of less than R2 000 000 (two million) per year) then the time bar will be the same as personal lines policies which is the 270 (two hundred and seventy) days.
If it’s not governed by PPR it will be governed by the time bar clause in the relevant policy wording. This differs from policy to policy and is normally 6 (six) to 12 (twelve) months but each wording would need to be checked.
8.6 Ombudsman Procedure
The Office of the Ombudsman for Short-term Insurance provides consumers with a free, efficient and fair dispute resolution mechanism. It offers consumers a “no risk” mechanism to resolve disputes with insurers.
The Ombudsman's office assists consumers with the following personal lines short-term insurance:
8.6.1 Motor
8.6.2 Buildings
8.6.3 Householders (Contents) including All Risks
8.6.4 Cell phone
8.6.5 Travel
8.6.6 Disability
8.6.7 Credit protection insurance.
8.7 There is no limit in terms of annual turnover relating to jurisdiction on complaints received by the ombudsman.
8.8 When a claim has been rejected, and the insured has approached the ombudsman
8.8.1 Hollard’s legal division will be notified of the Ombudsman complaint via the Ombudsman’s office.
8.8.2 Should further information be required by Hollard's legal team in order to formulate the response to the Ombudsman, contact will be made with the broker’s office.
8.8.3 The merits of the claim and the rejection will be discussed between the legal team and the Ombudsman.
8.8.4 Should the Ombudsman rule in the insured’s favour and determine that the claim should be settled:
8.8.4.1 Hollard will advise you of the decision.
8.8.4.2 settlement will be requested.
8.8.4.3 proof of payment needs to be sent to the representative in the legal team dealing with the matter in order to forward to the Ombudsman in order for them to close their file.
8.8.5 Should the Ombudsman rule in Hollard’s favour, you will be advised, and the file will be closed and prescription will continue to run on the claim. The insured has the option to issue summons on Hollard, which must be done before the prescription period ends.
Full Binder Claims Mandates and Guidelines – V3: 2019 Page | 11