Docs Category: Claims Procedure

GENERAL PROCEDURES

General procedures that apply during claims processingfrom notification to settlement:

1. Claims Notification

• Notification done either by letter, fax, telephone, e-mail, personal visit, company’s website and social media sites• Verbal reporting should be followed by written communication.• Late notification should be supported• Claims reported at the branch are registered and forwarded to head office

2. Claims Verification, Registration & Acknowledgement

Upon receipt the claim is then registered within the Insurance Claims system capturing the following information:• Details of the insured, policy number and period.• The date of loss and date of notification.• The nature and location of loss• The place where the loss occurred.• Estimated Loss/reserve guided by the Reserving Guidelines• Acknowledgement contains claim number,...

3. Appointment of Service Providers.

Service providers are as follows; MOTOR CLAIMS􀀀 Motor assessors – Material damage claims/partial theft 􀀀 Investigator – Motor theft and fire damage 􀀀 LPO issued to windscreen fitters – Windscreen and glass damage NON MOTOR CLAIMS􀀀 Loss adjusters – Fire, flood, theft, engineering, BI and other complicated claims 􀀀 Investigators – Bid and complex claims...

4. Motor Assessment and process

4.1 SETTLEMENT OPTIONS: MOTOR

These are the 5 main claim settlement options for motor insurance:

4.1.1 Cash- in- lieu (CIL)

Cahs In Lieu option can be done due to following resaons: Insured request, unavailability of parts or the insured not comfortable with the garage allocate. The insured is offered compensation to conduct the repairs. A percentage of the total repair cost is issued upfront (usually 70% or 50%) and balance issued after reinspection that confirms...

4.1.2 Repair authority

A repair authority is issued to a garage within the insurance company’s panel. nThe garage only starts repairing the car after receiving the repair authority.

4.1.3 Constructive total loss

A vehicle is considered written off in the event where cost of repairs exceed 50% of the vehicle agreed value. The insured surrenders ownership of the written off vehicle to the insurance company and get’s compensation as per the explained calculation here below. Agreed value/ PAV: xxxxxxAdd towing: xxxxxLess applicable excess: xxxxxxTotal amount: xxxxxx •...

4.1.4 LPO’s and reimbursement for windscreen

Windscreen damage claim can be setted through two methods: Local Purchase Order (LPO) Reimbursement

4.1.5 Reimbursement for repaired vehicles, to agreed limits

The insurance company might allow the insured to repair vehicle where cost of repair is below a set limit, for example Kes. 100,000 The insured then has to submit copies of receipts and get reimbursed for the incurred cost of repairs.

5. Motor Theft and fire claims

• Claims process is similar to that of total loss• However, for theft and fire, an investigator or a technical assessor is engaged for fire cases• Settlement is based on based on sum insured or pre-accident/pre-theft value depending on policy terms• Theft excess applies for stolen motor vehicles normally at 20% and 10% depending if...

6. Investigations

The following categories of claims should be investigated:• Motor accidents involving injury/death to third parties or passengers.• All Motor theft and fire claims must be investigated.• Any claims where the circumstances are not clear or fraud is suspected.

Loss Adjustment for Non- motor Claims

• Most insurer’s encourage in house loss adjusting• However, they engage external adjusters for complex claims• Adjusters can call for additional documents depending on the nature of claim• Adjusters advise the company on policy liability and quantum of loss incurred as well as Risk Improvement measures

7. Authentication

7.1. Review of documentsThe documents received are checked for completeness and correctness. A decision is then made onwhether the claim is payable or not.7.1.1. Motor Claims Review 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...