Page 37 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

Non-motor Claims Procedures
1.9 Appoint a contractor to do the repairs:
1.9.1 In accordance with the assessment report, provided that the insured is not under-insured.
1.9.2 Where there is under-insurance, the assessor has to provide us with full details of value at risk and average calcula ons before we obtain the signed Agreement of Loss and se le cash in lieu.
1.9.3 No authorisa on can be given for repairs where the insured is not adequately insured (for example, where average applies).
1.10 Where you have provided authorisa on for replacement of any items diarise your le and follow up on invoices. Once the invoice is received be sure that you proceed with payment only once you have:
1.10.1 received a signed release or delivery note from the Insured, and
1.10.2 received the original vat invoice, not an e-mail document.
1.11 Ensure that you compare the invoice amount to the amount that you have authorised or that has been agreed by the loss adjuster. If the amount of the invoice does not match the authorised amount, inves gate and always ques on any addi onal amount that may not have been agreed upon.
1.12 Where the claim may be considered as a possible rejec on:
1.12.1 Prepare the le together with all the claims documenta on, and forward copies to Hollard.
1.12.2 Based on the merit of the ma er and considering the policy wording Hollard may decide on proceeding with a rejec on by drawing up a rejec on le er. The original rejec on le er will be forwarded to the client via registered mail and a copy of the rejec on le er will be forwarded to you to place on your claims le.
1.12.3 Please note that it is impera ve that any possible rejec on be properly communicated to the client and explained.
1.12.4 Please also note that the claims decision from Hollard's perspec ve should always adhere to the claims philosophy as set out and agreed by Hollard.
2. GUIDELINES FOR APPOINTING LOSS ADJUSTERS
It is important to remember that the claims department of an insurance company is the showcase of the company, and whilst the Loss Adjuster is independent, in the public eye he represents the company.
Please ensure loss adjuster/motor assessor is advised of our requirements.
2.1 Common bene ts and reasons for appoin ng loss adjusters
2.1.1 Indica on of moral hazard.
2.1.2 Report on physical hazard.
2.1.3 Checking adequacy of Sum Insured.
2.1.4 Advising of insurance history.
2.1.5 Handling the complexity of a claim and to adjust claim accordingly.
2.1.6 Refer to specialists for repairs and replacement to adjust claim accordingly.
2.1.7 Where there is doubt regarding circumstances and quantum and/or fraud is suspected, thorough inves ga on is to be undertaken.
2.2 Loss adjusters' responsibili es
2.2.1 All reports to be addressed to Hollard care of the Broker and sent to the Broker.
2.2.2 The loss adjuster must conform to a Code of Conduct and Ethics laid down by the ILA and have professional indemnity insurance in place.
2.2.3 The loss adjuster may not conduct any other form of con ic ng business.
2.2.4 Con ict in interpreta on of policy wordings – the loss adjuster must consult with the Principal, and present his own views. He must, however, follow Principal's guidelines and instruc ons and not venture into o ering legal opinions.
Binder Claims Mandates and Guidelines – 2015/2016 Page | 35