PRESENTATION AT MANAGEMENT RETREAT 2013

1. PRESENTATION AT MANAGEMENT RETREAT 2013 CLAIMS HANDLING PROCEDURES

2. DISTINCTION BETWEEN A CLAIM AND A LOSS • A claim can be made (i.e. notified) without an insured loss event happening . • In this case the claims is invalid • An insured loss event is an occurrence which is covered under the terms of the policy. • In such a case, the claim would be valid.

3. DISTINCTION BETWEEN A CLAIM AND A LOSS • Similarly, an insured loss event can occur without a claim being made. • Where, for example, the insured is unaware that the cover extends to the particular peril, there is a potentially valid claim but since the claim is not presented, the insured is not reimbursed

4. Documentation Requirement • Accident Report form in all claim cases • Letter / Statement of claim( in the case third party claims) • Pictures of the loss or damage • Driver’s License • Police report or Fire Service report • Cost of repair or invoice • Medical Report • Medical Bills

5. Documentation Requirement • Sworn affidavit • Labour sheet 1&2 in the case of Workmen. • Passport size pictures • Letters of Administration • Death Certificate/Burial Permit Compensation Claims Requirment

6. EXAMPLES • MOTOR • Completed motor claims form • Estimated cost of repairs • Police Report Covering the accident • Submission of photocopy of the drivers license • Availability of the damaged vehicle for inspection/survey.

7. EXAMPLE • THIRD PARTY INJURY • Police Report • Comprehensive Medical Report • Sworn Affidavits • Personal particular of the claimant • Two passport-size photographs of the victims duly endorsed.

8. Example • Deceased Claim • Police Report • Death Certificate/Burial Permit • Letters of Administration(for all adults) • Sworn Affidavits • Two passport-size photographs duly endorsed(one endorsed by the attending medical officer)

9. EXAMPLE • FIRE • Early notification of Claim/Completion of Claim form • Survey report • Fire Service officers report • Estimates of repairs/replacements

10. CLAIMS HANDLING PROCEDURES • INVESTIGATION • SETTLEMENT • DISCHARGE

11. CLAIMS HANDLING PROCEDURES • INVESTIGATION • Check the information contained in the claim form against the underwriting information held

12. CLAIMS HANDLING PROCEDURES • CLAIM REGISTERATION • The claim is assigned a unique number with the Claim details imputed into Cibas(Claimant details and estimates are captured) • Check Premium Status • CLAIM SETTLEMENT • Negotiate on Settlement • Liability Report • DISCHARGE/PAYMENT

13. THANK YOU