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Long Term Insurance Act, 1998 (Act No. 52 of 1998)

Policyholder Protection Rules (Long-term Insurance), 2017

Chapter 3 : Products

Rule 2A : Microinsurance and Funeral Policy Product Standards

2A.8 Claims

 

2A.8.1 Subject to rule 2A.8.2, an insurer must, within two business days after all required documents in respect of a claim under a microinsurance policy or a funeral policy have been received—
(a) assess and make a decision whether or not the claim submitted is valid, and
(b)
(i) authorise payment of the claim;
(ii) repudiate the claim; or
(iii) dispute the claim and notify the claimant of the dispute.

 

2A.8.2 If a claim is disputed as referred to in rule 2A.8.1(b)(iii), the insurer within 14 business days after expiry of the period referred to in rule 2A.8.1—
(a) may further investigate the claim;
(b) must make a decision whether or not the claim submitted is valid; and
(c) must pay or repudiate the claim.

 

2A.8.3 An insurer may not repudiate a claim under a microinsurance policy or a funeral policy on the basis that the policyholder did not disclose information, if the insurer did not specifically request the policyholder to disclose that information before the inception of the policy.

 

[Rule 2A.8 inserted by rule 6(c) of Notice No. 997, GG 41928, dated 28 September 2018]

 

 


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