Claims Procedure
When an Insured Event happens which may result in a claim you or any other person who seeks to claim against your policy must proceed as follows:
- Notify us or the Insurer, as soon as possible after the event, and provide us with details of any other policy which may cover the same event. You may notify us via telephone on 012 346 3001 or e-mail to claims@helfin.co.za;
- Supply us or the insurer with full details of the events no later than thirty (30) days after the event giving rise to the claim;
- Supply proof of both the ownership and value of any item that you are claiming for, when requested to do so;
- Supply written proof, information and sworn declarations that may be required in relation to the event and the loss of any item that you are claiming for not later than fourteen (14) days after being so requested;
- Report any event to the Police within forty-eight (48) hours if it involves a motor accident, bodily injury, theft or other criminal act or suspected criminal act or loss of property and take all practicable steps to discover the guilty party and recover the stolen or lost property;
- Forward any letter of demand, summons or similar document or process received, relating to any claim within forty-eight (48) hours of receiving it;
- Do not make any statement, admission, offer, promise or payment or give indemnity to any party. Never admit guilt nor offer a settlement to any party involved in an incident in which you are involved as this will hinder the defence any claim. We will not be bound by any admission or offer you might make to any party in relation to any incident;
- Always supply true and complete information. All documentation and information which is provided in substantiation or support of any claim must be true, complete and correct;
- The insurer may take or keep possession of your damaged property. You are not entitled to abandon any property to them whether they take possession of it or not. They may elect to take ownership of the salvage and dispose of it any manner considered reasonable;
- You must allow the Insurer to enter the premises where the loss or damage took place and to take possession of the damaged property covered, and to deal with it in any reasonable manner.
Subrogation
- You must allow the insurer to do everything that may be necessary, or reasonably required by them, to enforce their right to claim on your behalf and in your name whether before or after they have settled the claim.
If you do not allow them to take this action, you may lose all benefits under your Policy and be required to repay to them any benefit you have already received from them.
- When the insurer settles a claim, your rights to claim against other people are automatically transferred to them.
- You must supply all information and assistance which the Insurer may reasonably require and they have the right to take over the defence or settlement of any claim and conduct it in your name.
- They have the right at any time to relinquish the control of any defence, settlement or proceedings and to pay you the full amount of their liability, or any lesser amount for which we consider that the claim can be settled, after which we will not have any further liability to you.
Settlement of Claims
- The Insurer may decide whether they want to settle your claim by repairing or replacing or reinstating or by paying the value in cash, less the value of the damaged property or a combination of these, but subject always to within the maximum amounts stated in this Policy less any First Amount Payable as detailed in the First Amount Payable Section of your policy.
- You may have to sign a release prior to claim settlement.
Consent to Disclosure of Private Information
- It is essential for insurance companies to share claims and underwriting information (as well as credit information) in order to enable the fair assessment and underwriting of risks and to reduce the number of fraudulent claims.
- On Your behalf and on behalf of any person you represent herein, you hereby waive any right to privacy in any insurance information provided by you or on your behalf for any insurance policy or claim made or lodged by you and you agree to such information being disclosed to any other insurance company.
- The information provided by you may be verified against other sources or databases.
- You also waive any rights of privacy and consent to the disclosure of any information relevant to any insurance policy or insurance claim concerning yourself.
Insurable Interest
- You must have a financial insurable interest in any item insured under this Policy throughout the period of cover of this Policy and also at the date of any event.
- ‘Insurable Interest’ means that you are the owner of, or alternatively the good faith possessor in terms of a credit agreement of the insured item and bear the risk of financial loss of the item.
- Should your insurable interest in any item insured under this Policy change you must notify the insurer in writing of such change.
Prevention of Loss, Damage or Liability
If You take any deliberate risk that results in loss, damage, death, injury or liability that could give rise to a claim, You will forfeit the right to claim in terms of this Policy.
Rights of Others
A Policy gives rights to you only. Any extension of the insurer’s liability for the losses of any other person gives no right to that person to claim. Only you may claim against your Policy. You may not cede your rights.
Contribution
In the event that there is any other insurance policy or policies covering the property against loss or damage or liability insured in terms of a Policy, each Policy will only provide cover for a pro-rata portion of any claim that you may have.
Accuracy of Material Information
A Policy or any part of it can be declared of no effect if any details which affect the decision to provide cover in terms of the Policy or if any information that would affect the decision to provide you with the cover in terms of this Policy is withheld.
Deliberate or Fraudulent Acts in Making a Claim
All benefits afforded in terms of a policy in respect of any claim shall be forfeited and the Policy may be voided or cancelled at the insurers discretion from the date of any fraudulent conduct and all premiums paid in respect of such claim shall be forfeited and the policy may be avoided or cancelled from the date of the fraudulent conduct.If any claim or part thereof under the Policy is in any way fraudulent or if fraudulent means or devices are used by you or anyone acting on your behalf to obtain any benefit under this Policy, or if any Insured Event under a Policy is occasioned by your intentional conduct or any person acting on your behalf or with your connivance will invalidate the claim.if any fraudulent information or document, whether created by you or any other party is provided to the insurer by you or anyone acting on your behalf or with your connivance in substantiation or support of any claim under the Policy and whether or not the claim itself is fraudulent;
Prescription
- The Insurer is not liable after twelve (12) months have expired from the date of the event that gives rise to a claim, unless the claim is the subject of a pending court action, or is a claim for sums for which you may become legally liable to a third party.
- If the Insurer declines liability for a claim made in terms of a Policy or you dispute the amount of any claim, written representation may be made within ninety (90) days of the date of the letter of rejection or avoidance.
Your representation must be submitted in writing to:
The Ombudsman for Short Term Insurance PO Box 32334 Braamfontein 2017 Phone: ( 011) 726 8900 Fax: (011) 726 5501
If your dispute is not satisfactorily resolved in this manner, you may institute legal action against the Insurer for the enforcement of the claim by way of the service of summons against the Insurer.