Page 8 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

2.3 Technical assistance
There may be situations where you are faced with uncertainty. These claims can then be referred to the claims specialist in the Region in order to assist you in taking the correct action. With regards to Specialised Claims Services (Recoveries and Liabilities), these claims can then be sent to Hollard in order to assist in taking the correct action. Please always ensure that all claims documentation is provided in order for Hollard to make the correct decision on the claim.
Specialised Claims Services (Recoveries and Liabilities) – louisd@hollard.co.za
2.4 Claims documentation required
When referring a claim to Hollard
Always provide the following documentation in order for Hollard to make a decision on the claim:
2.4.1 Claim form
2.4.2 Policy schedule
2.4.3 Premium confirmation
2.4.4 Assessor/loss adjuster’s report with photos or addendums
2.4.5 Driver’s licence in the case of a motor vehicle accident
2.4.6 Identity document in the case of foreigners or temporary residents in South Africa
2.4.7 Technical reports
2.4.8 Claims history
2.4.9 Quantum documentation
2.4.10 Investigator’s report
2.4.11 Any additional information that we may require to make a decision on the claim.
3. GENERAL CLAIMS PROCEDURES
3.1 The Policyholder Protection Rules (PPR) stipulate certain time frames that must be adhered to in respect of all claims, and the time frames below apply to all sections.
3.1.1 A claim must be recorded within 1 (one) business day after the date of receipt of the initial claim. There must be no delay recording the claim if information is still outstanding.
3.1.2 A decision to accept or repudiate a claim must be taken within a reasonable period of time.
3.1.3 Once a decision is taken, a claimant must be notified within 10 days of the decision.
3.2 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.
3.2.1 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.
3.2.2 Verify that the client has the appropriate cover for the type of claim submitted. Evidence should be made available on request.
3.2.3 Ensure that all the required documents are on record. If any documents are missing, take steps to obtain them, for example request by email and keep request on record.
3.3 Check that the necessary steps have been instituted to have the claim processed as soon as possible (assessor/investigator appointed, etc.).
3.4 Check the claims history of the claimant to:
3.4.1 cross-check information on proposal and verify information such as disclosures made by the insured on the proposal related to the risk which the claim pertains to; check previous claims history; check previous insurance history disclosed
3.4.2 determine whether there is a possible trend in the claimant’s claim submission
3.4.3 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 condition of vehicle, alarm/mobiliser, radio, etc.)
General Procedures
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Full Binder Claims Mandates and Guidelines – V3: 2019