7.1. Review of documents
The documents received are checked for completeness and correctness. A decision is then made on
whether the claim is payable or not.
7.1.1. Motor Claims Review
- The assessors report is reviewed. If the vehicle is declared a total loss (usually where the repair cost is
more than 50% to 70% of the sum assured), a discharge voucher of the Agreed Value/ the Assessed
pre-accident value (PAV) less the excess(Applicable) is prepared for execution by the claimant.
- For Repair cases,
• The insurer can issue a Cash in Lieu (CIL)Discharge Voucher – 1st CIL DV of 70% and 30% issued once repairs are complete and the vehicle is re-inspected.
• Or issue a Repair Authority to a panel garage and once repairs on motor vehicle are complete, release of the vehicle is done after the following conditions are met:
• The claimant pays the policy excess, as per the policy.
• Payment of any outstanding premiums
• A written authority to release the vehicle is given by the company to the garage
• The claimant signs a Satisfaction Note.
- For total loss motor vehicles where the insured is not retaining the salvage, the original log book, signed blank transfer forms, copy of national identity card or certificate of incorporation, the insurance certificate and the car keys must be surrendered to the company before settlement of the claim.
7.1.2. Non Motor Claims Review
• For non- motor claims the loss adjuster’s report is received and checked for reasonableness and if acceptable a discharge voucher is prepared and sent to the claimant (usually through their intermediary) for execution. The discharge voucher will be net of policy excess, which is a percentage of the claim or sum assured depending on the class of business.
– Any salvage must be released to the insurance company before the claim is settled.
– For GPA and WIBA claims the medical certificate is received after the claimant has fully recovered. If the certificate from the attending doctor is not in line with the Continental scale, a second opinion is sought
from a doctor on the insurer’s panel of approved doctors.
• Premium payment must be confirmed before the claim is paid.
• Once a claim has been verified as payable and all relevant claim supporting documents have been received, claims handler shall issue a discharge voucher indicating amount being offered for settlement of claim.
• Issuance of DVs does not apply for motor repair claims, where payment is made to motor repairer.
• A discharge voucher shall be raised upon full documentation and verification.
• A letter giving breakdown of settlement amount shall accompany discharge voucher.
• DV shall be accompanied by a forwarding letter showing computation of offer amount.
• Upon receipt of the duly executed discharge voucher and all claim documentation, the claims handler then raises a payment requisition and the same is duly approved as per the authority limits and forwarded to finance for settlement. A settlement cheque, RTGS or EFT payment shall then be forwarded
to the claimant or their intermediary.
Claims may be declined on various grounds, including the
• There is late notification without a valid/acceptable reason;
• Premiums have not been paid
• There is proof that claim is fraudulent;(mis-representation of material fact/utmost good faith)
• There has been breach of policy conditions or warranties related to claim in question;
• There was no cover for items being claimed;
• Claim falls outside policy scope of cover