Page 9 - Personal Underwriting Mandates & Guidelines - Binder product rules & addendums - Version 1

General Procedures
5. EX GRATIA PAYMENTS
5.1 If a claim has been rejected and it has been decided in your o ces to request an ex gra a payment, the following is required:
5.1.1 Ex gra a request form
This form, detailing the reasons for the request, must be signed by management (a director or shareholder) and forwarded to Hollard together with any suppor ng documents.
NOTE: The reasons for gran ng the ex gra a payment are con den al 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 exis ng policy, and is made without any admission of liability.
5.2 Once you have been advised that the ex gra a payment has been approved:
5.2.1 prepare a le er addressed to the Insured advising him of the ex gra a payment as well as any condi ons applicable thereto
5.2.2 obtain a signed ex gra a 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 ins tu on who has an interest in the vehicle rst and foremost.
NOTE: An ex gra a payment is made based on the condi on that no admission of liability is accepted in terms of the policy, we cannot ins tute a recovery ac on, nor can we retain the salvage, unless we ensure that we make this a condi on of payment, and the Insured has agreed to this in wri ng to the ex gra a agreement of loss. Furthermore, it must be noted that we cannot entertain a third-party claim or a liability claim or any other liability claim.
6. CHECKLISTS
Before any claim may be nalised the following have to be checked on claims for all classes of business:
6.1 Always check the policy wording rst in order to consider if the loss was caused by an insured peril or event. Please also note and compare claims to all exclusions, terms and condi ons of the policy.
6.2 Con rm that the premium for the appropriate month of cover has been paid. Has the premium been paid up for the period of insurance in which the claim occurred?
6.3 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 en ty or person can be appointed by him with the appropriate power of a orney to complete the claim on the client's behalf. If the client is deceased, an executor of his estate would be granted power of a orney.
6.4 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.
6.5 Did the client select the appropriate cover to allow a valid claim on that sec on of the policy and is the Sum Insured adequate? Is there an Insurable interest?
6.6 Check whether the claim was submi ed within the me limit allowed.
6.7 Consider if the client has had similar losses previously, either within the me of being insured with you or previous insurance. This will allow you to see if there may have been correc ve underwri ng or addi onal 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 speci c terms and condi ons.
6.11 Check previous claims history, and/or previous insurance.
6.12 Salvage: where applicable we require a full report from the repairer – a damage report.
6.13 Do reinsurance and/or co-insurance contribu on apply?
Binder Claims Mandates and Guidelines – 2015/2016 Page | 7