The, Insurance Regulatory Authority (IRA) yesterday introduced three insurance guidelines that are aimed at making the insurance sector friendlier to the local mwananchi, which were expounded upon, here .
One of the new guidelines is claim management for the insurance industry. The Authority developed this set of claims management guidelines to enhance efficiency, transparency, and disclosure of information to policyholders during the claims processing and to increase consumer satisfaction. We have compiled a couple of pointers from the guideline that might be relevant to you.
Pre-loss information
Section 4 of the guideline is mainly concerned with information or instructions an insurer should provide an insured individual with before a loss occurs. Some of the information include: Providing instructions on what a claimant should do when a loss occurs, loss minimization, importance of reporting a claim in a timely manner as provided for in the policy and need to allow the company to handle inspection and assessment of damage before settlement, just to mention a few.
Loss notification & acknowledgement
Section 5 of the guideline is mainly concerned with how one can report a claim when a loss occurs. For starters, the claimant is advised to use any fast means of communicating to the insurer’s designated contact person or department or through the intermediary by one of the following means:
- Direct reporting
- Telephone call
- Text message
- Fax
- Letter
- Use of social sites or websites
- Any other form of technology of wide usage
When you use a mode of communication that lacks written evidence, the insurer shall inform you of the need to follow up on such communication with a letter and/or completion of the appropriate claim form.
When the insurer receives a claim notification, it must to take the following actions within seven working days: First acknowledge the notification, avail an appropriate claim form to the claimant and specify documents required when filing a claim. The insurer should also provide any additional information/advice that will help in dealing with the claim. Where another insurer is involved in the claim, the insurer should contact them within a reasonable time and resolve inter insurance claim disputes as quickly as possible.
Once the claimant has submitted all the necessary documentation, the insurer should acknowledge receipt of the documents within 7 working days. The date of acknowledgement will be taken as the date when the claim was reported.
Where a claim is admissible and can be settled immediately without any farther assessment, the insurer shall affect the settlement of the claim fast and efficiently.
Situations may arise where farther assessment by a service provider may be necessary to quantify the loss. In such a case the insurer should promptly appoint a service provider and advise the claimant on the actions being taken. Once the insurer receives the assessment report, they will then make an offer to settle the claim.
Where further investigation is necessary to determine the admissibility of the loss under the policy, the insurer shall notify the claimant of this requirement, explain and emphasize on the need to cooperate with the investigators.
If it is the opinion of the insurer that the loss is not covered by the insurance policy, or the amount offered is different with the amount claimed or where the insurer is not responsible for any part of the claim, the insurer shall promptly notify the claimant of this fact and explain the reasons.
Download the full PDF here: Guidelines on Insurance Claim Management for The Insurance Industry