Trafalgar Financial Services has a full claims department that deals with our insured client’s insurance claims directly; we deal with the insurer on behalf of the client.
Generally, the claims go to the branch concerned who in turn will complete a generic claim on behalf of the client and forward same to TFS.
Once we receive the claim form, it will be allocated to the necessary claims consultant depending on what the peril (claim) is for.
Our claims consultant is required to make an outbound call to the unit owner to verify the claim, due to the fact that the client is not required to complete an insurer claim form. All the insurers we deal with take the voice recording where the claim is verified with the unit owner as confirmation of a legitimate claim.
Once the claims consultant has all the relevant details pertaining to the peril, they will register the claim with the insurer and our system.
OTHER METHODS OF CLAIMS BEING SUBMITTED
We also accept e-mails registering claims, we will need the unit owners contact details and what the claim is for and will then follow the same process as above.
Telephonic claims are also received, and will be register directly over the phone with the unit owner if same is reporting the claim.
It is preferable that if the event takes place during normal business hours, that we (TFS) do the appointing of the contractors who are on our preferred contractor’s panel, this alleviates confusion over excess payments etc.
All excesses payable on a claim are due to be paid up front to the contractor when the contractor arrives on site to do the repairs, unless the client has an excess waiver policy in place being Trafex or Trafex Plus, which will cover the excess up to the maximum limit offered on the policy which is dependent on which policy is in place.
We will then be able to advise the contractor of the excess up front and the client, and also confirm whether or not there is a Trafex or Trafex Plus policy in place.
TIME FRAME IN WHICH A CLAIM NEEDS TO BE REGISTERED
All claims no matter what the peril is, needs to be notified to TFS/Insurer within 30 days of the event occurring, e.g. if the event happened on 1 June we need to be notified no later than 30 June in order for us to notify the insurer.
Due to the fact that the insurer may have been prejudiced due to the delay in the claim being registered, meaning has they been notified in time, the damages could have been attended to sooner and thereby the cost of the claim would be less. The insurer always needs to be made aware of any impending claim irrespective to whether or not all the information is available.
GENERAL INSURANCE INFORMATION
There can only be an insurance claim if there is an insured peril that occurred.
All claims must have an exact date of loss very specifically when it comes to lightning damage claims as the insurer will check with the weather bureau if there was lightning on the day in the area. If it is determined that there was no lightning the claim will in all likelihood be repudiated (declined).
TYPES OF EVENTS THAT WILL NOT BE COVERED BY INSURANCE
This is building insurance and therefore only covers the fixtures and fittings of the property concerned and NOT any moveable items.
The following will not be covered under this policy:
ROOF LEAKS (DUE TO MAINTENANCE) it is the B/C responsibility to maintain the roof of the premises and ensure regular maintenance is done as this forms part of Common Property.
LEAKING PIPES – whether it is inside a wall or external, leaking pipes are not covered at all and will be for the owners account to repair that would include the breaking of a wall, tiles etc. if so required. If the leaking pipe has caused resultant damages inside the unit a claim can be submitted for this, provided that the leak was not ongoing for months on end and not attended to. The insurer then has the right to repudiate the claim based on a lack of maintenance.
BURSTING PIPES – These are generally also not covered, but may be in certain circumstances. If a claim is submitted for a burst pipe, the owner would need to get it attended to and get the plumber to submit a full report as to the cause of the burst pipe for further consideration by the insurer.
As part of piping – leak detection is not covered by the insurers – should a leak detector needs to be called out to trace a leak, it will be for the owners account.
OLD DAMAGES – any old damages inside a unit will also not be covered, as these are distinctive and will be noted by an assessor.
DEFECTIVE DESIGN, DEFECTIVE MATERIALS, POOR WORKMANSHIP & DEVELOPER ISSUES – none of these items are covered by insurance under any circumstances. New developments, will not be covered for any developer issues for the first 5 years of cover as these items need to be referred back to the developer to attend to, part of this includes items under this heading.
In terms of excess payments on any insurance claim the Prescribed Management Rules of the Act states the following:
A member is responsible —
(b) for any excess amount that relates to damage to any part of the buildings that member is obliged to repair and maintain in terms of the Act or these rules, and must furnish the body corporate with written proof from the insurer of payment of that amount within seven days of written request.