Claims Guide

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CLAIMS GUIDE

Claims Guidance Notes

The intention of these notes is to provide you, our valued client with a summary of procedures commonly adopted for Claims but these do not in any way purport to cover every claims situation. Evolving technology and industry wide changes can and will continue to affect claims reporting procedures and the safest course of action is to notify your Insurers or us at the following contact numbers if you need claims assistance or upon the happening of an insured event or accident or incident WHETHER OR NOT a claim will eventually be made. This is in fact a condition precedent to liability under most contracts of insurance.

ACT AS PRUDENT UNINSURED

In all instances you are required by policy conditions to act as though uninsured and to take all precautionary measures to prevent and minimize further losses.

THE COMMON SENSE APPROACH

What are the steps you would take if you were uninsured? The steps you take as an Insured ought to be no different other than as if you were not insured. This is often called acting a prudent uninsured. The loss or damage you suffered remains your responsibility until such time the Insurers admits liability for the loss. The Claims Manager and Loss Adjusters is not an enemy. They are competent persons instructed by the Insurers to arrive at a fair value for your loss or damage and must rely frequently on documents to be furnished by you. Incomplete and inadequate information or documents slow down the claims process. Call MUTUAL and ask for help if you are not sure what documents will assist you. MUTUAL is here to help you and recognizes the fact that Claims Assistance is our duty, professional obligation and our promise to you.

The Insurers must know you had a claim, he must have adequate information on the claim to instruct Loss Adjusters and the Loss Adjusters must have adequate evidence of the loss and damage you suffered in order that your claim can be processed. Therefore, always be as informative as you can when advising a loss.

A) PROPERTY DAMAGE AND PECUNIARY CLAIMS

  1. Notify us immediately on the happening of loss or damage and provide adequate details such as the date and time of loss, the circumstances of the loss and location. MUTUAL will act promptly to notify your Insurers who will appoint a Loss Adjuster to conduct a survey.
  2. Preserve damaged property in its present condition for loss adjuster’s inspection of the extent of the loss/damage.
  3. Notify the Police Authorities immediately following any fire, burglary, theft or attempted break-in, robbery, malicious damage or loss of property or money.
  4. Do not admit liability or offer/compromise any settlement for losses or accidents resulting in any third party claims. Admission of liability is solely the prerogative of your Insurers.
  5. Wherever applicable, to protect property that has been damaged to prevent further losses or deterioration. Wherever possible or appropriate, take photographs of the scene of the accident.
  6. Extend your fullest co-operation to any surveyor or loss adjuster appointed by the insurer.
  7. Keep MUTUAL and your insurers informed of all developments in the matter so that your claim is continuously monitored for efficient claims handling and for us to provide you with assistance in the claims procedures and formalities. Where an audit fee is incorporated in the policy, seek insurer’s approval to use auditors for the purpose of preparing the statement of Consequential Loss claim.

B) CONSEQUENTIAL LOSS

  1. Take preventive measures against further material damage losses.
  2. Take measures to maintain turnover by economical means. It is essential that all possible steps to be taken to minimize loss and expedite repairs with due diligence and dispatch.
  3. DO NOT commence with material damage repairs until AFTER prior approval from Insurers/ Loss Adjusters.
  4. Maintain separate records fro the following:- Increased costs of Working such as overtime payments, alternative premises, additional transportation, temporary repairs etc, in an effort to maintain turnover, if incurred. Trading and costs following the date of loss to prove the reduction in turnover suffered. In other words, to take note of :-
    1. charges that continue to be spent during the indemnity period and;
    2. turnover maintained during the indemnity period
  5. To submit following supporting claims documents:- Financial Report of Last Financial year Records of increased cost of working during the indemnity period
  6. Where an audit fee is incorporated in the policy, to seek insurer’s approval to use auditors for the purpose of preparing the statement of Consequential Loss Claim.

C) LIABILITY CLAIMS

  1. Notify us immediately in the event of property damage and/or bodily injury to third parties.
  2. Do not admit liability or make any offer, promise to pay, payment and to refrain from any negotiations with the third party or any other interested party.
  3. Take all possible measures to prevent further losses. To preserve (where possible or appropriate) all evidence surrounding the scene of the accident pending investigation by Insurers/ Loss Adjusters
  4. Where appropriate, take photographs of the scene of the accident.
  5. To forward all communications from the third party or other interested party or their solicitors to us unacknowledged for our further attention.
  6. To complete and return to us the claim form.
  7. To permit insurer’s/ loss adjusters to investigate and offer your full co-operation to the loss adjuster.

D) WORK INJURY COMPENSATION ACT

  1. Contact us immediately if it is a fatal or serious accident.
  2. Give notice to the Ministry of Manpower on Notice of Accident Form A within 10 days of occurrence of accident to your workmen as required under the Workmen’s Compensation Act. Breach of this requirement carries a fine.
  3. To send injured employee for medical treatment immediately after an accident and to keep records of all follow-up treatments.
  4. To complete claim form and to submit it to us when available all the Medical Certificates and medical bills.
  5. To have Ministry of Manpower (MOM) Medical Report Form completed by the doctor attending to the employee and return it to the MOM.
  6. To forward us a copy of the Assessment of Compensation when made available by the MOM.
  7. Payment of compensation awarded must be made to injured employee within 21 days of service of the Notice of Assessment.
  8. If the injured workman indicates that he does not wish to accept the compensation awarded by MOM and he therefore intends to pursue a Common Law claim against you for negligence, please act as follows:
    Do not admit liability under any circumstances
    Forward all letters, writ of summons, process etc received from the injured employee and/or his/her solicitors immediately unanswered to us for further action by the insurer.
    Any objection must be communicated to the MOM within 14 days of the service Of Notice of Assessment. Otherwise, interest will be levied for late payment.

E) GROUP PERSONAL ACCIDENT

  1. Contact us immediately if it is a fatal or serious accident.
  2. Send the injured employee for medical treatment and to keep tab on follow-up treatments.
  3. Complete Claim Form and return it to us together with the medical report, medical bills, medical leave certificates and any other relevant supporting documents.
  4. In the event of a death claim, to obtain an Autopsy Report and Death Certificate.
  5. Lodge a report with the police.

F) GROUP HOSPITAL & SURGICAL CLAIMS

  1. Complete claim form to be signed by both the employer and the employee/claimant.
  2. Request the doctor or surgeon concerned to complete and sign on the “Medical Report” section on the reverse side of the claim form for Private Hospitals and /or Clinics. However, if claimant is warded in any of the Government Hospitals, to complete the Medical Report Authorization Form.
  3. Pay the hospital/doctors all the charges/ expenses first. If Medisave is used, complete the Medisave Authorization Form.
  4. Attach all the original bills and receipts, together with the relevant supporting claim documents as noted above and send them to us for further processing.

G) MOTOR VEHICLE AND ACCIDENT CLAIM

  1. Complete the Accident Statement (Part 1) jointly with the other party. If this is not possible, fill in your side of the Statement.
  2. Obtain the registration numbers of ALL the other vehicles involved in the accident.
  3. Obtain the names, addresses and contact numbers of all the other drivers/Owners and witnesses
  4. Try to take photographs of the scene of the accident.
  5. Do not discuss or admit liability to the others involved in the accident or their lawyers even if it appears to you that you are at fault. Refer all communications from them to your Insurers or us.
  6. If an accident involves injury, call the Police immediately. You must also make a Police Report within 24 hours of an accident involving. Damage to a government vehicle or Property. Foreign registered vehicle. A hit and run vehicle
  7. Notify your Insurers through the on-line reporting service. On-line reporting can be done at IDAC, some authorized workshops and insurance companies where you get assistance. If you are unsure where to go, call MUTUAL.

H) MARINE CARGO / AIRFREIGHT CLAIMS

  1. Upon being notified by your transport agent of any sign of external damage to your cargo, instruct them not to take delivery.
  2. Call us immediately to arrange for survey and claim on the Carriers, Port/Airport Authorities, transport agent, suppliers or other Bailees for any missing/ damaged packages.
  3. To apply immediately for survey by Carriers’ or other Bailees’ Representatives if any loss or damage is apparent and claim on the Carriers or other Bailees for any actual loss or damage found at such survey. If carriers refuse a Joint Survey, to write a Letter of Protest, to give clean receipts, where goods are in doubtful conditions.
  4. In no circumstances, except under written protest, to give clean receipts where goods are in doubtful conditions.
  5. When delivery is made by Container, to ensure that the Container and its seals are examined immediately by your responsible official.
  6. If the container is delivered damaged or with seals broken or missing or with seals other than as stated in the shipping documents, to clause the delivery receipt accordingly and retain all defective or irregular seals for subsequent identification.
  7. To give notice in writing to the Carriers or Bailees within 3 days of delivery if the loss or damage was not apparent at the time of taking delivery.
  8. To enable claims to be dealt with promptly, submit all available supporting documents without delay, including when applicable:-
    1. Original Policy
    2. Original or copy of shipping invoices
    3. Suppliers invoices
    4. Packing List
    5. Survey Report or other documentary evidence to show the extent of the loss or damage.
    6. Copy of Bill of Lading/ Airway Bill (with printed conditions)
    7. Landing account and weight notes at final destination
    8. Correspondence exchanged with the Carriers and other parties regarding their liability for the loss or damage.
    9. Claim bill in triplicate
    10. Any other relevant supporting documents.

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