1. Operational and Actuarial Aspects of Takaful Topic 7 Claims Management

2. Sub Topics Importance of Good Claims Management Importance of Good Claims Management Family Takaful Family Takaful General Takaful General Takaful Third Party Claims Assistance Third Party Claims Assistance Claims Disputes Claims Disputes

3. Importance Claim is the ultimate test of responsibility of the takaful operator to compensate the economic loss of the participant as promptly and fairly as possible Claim is the ultimate test of responsibility of the takaful operator to compensate the economic loss of the participant as promptly and fairly as possible Good claim services contributes to good image and better competitive position Good claim services contributes to good image and better competitive position Takaful operators have the right to safeguard its role as the trustee of the takaful fund by ensuring that all claims are genuine Takaful operators have the right to safeguard its role as the trustee of the takaful fund by ensuring that all claims are genuine

4. Claims Processing General procedure for claim applicable to all classes of family and general takaful plans : General procedure for claim applicable to all classes of family and general takaful plans : Check the policy or certificateCheck the policy or certificate Notify the takaful operatorNotify the takaful operator Provide complete and correct informationProvide complete and correct information Keep copies of all documentsKeep copies of all documents Communicate frequentlyCommunicate frequently

5. Family Takaful Claims Death claims: Death claims: Proof of deathProof of death Proof of ageProof of age Proof of title and ownershipProof of title and ownership

6. Family Takaful Claims Maturity claims Maturity claims To settle a maturity claim, a participant is usually required to provide the following proof of claims:To settle a maturity claim, a participant is usually required to provide the following proof of claims: If the participant is the insured If the participant is the insured - Proof of age - Proof of survival - Completed discharge voucher - The original policy certificate If the participant is not the insured If the participant is not the insured - a deed of assignment - a statement by the insured proving that he/she is alive and is unable or not available to sign the survival certificate

7. Family Takaful Claims For endowment policies, operators would normally incorporate common settlement options such as: For endowment policies, operators would normally incorporate common settlement options such as: Cash proceedsCash proceeds Conversion to annuityConversion to annuity Leave maturity proceeds to the operatorLeave maturity proceeds to the operator Personal Accident, Sickness or Disability Benefit Claims Personal Accident, Sickness or Disability Benefit Claims For the above stated claims, the participant must prove to the satisfaction of the operator and comply with all other conditions of the contract ; for personal accident policies the doctorine of proximate cause is important;For the above stated claims, the participant must prove to the satisfaction of the operator and comply with all other conditions of the contract ; for personal accident policies the doctorine of proximate cause is important;

8. Family Takaful Claims It is customery for operators to issue form so as to elicit information about the accidents and validation of all the documents given ; among the documents required for personal accident claims includes : It is customery for operators to issue form so as to elicit information about the accidents and validation of all the documents given ; among the documents required for personal accident claims includes : Medical leave chitMedical leave chit Medical reportMedical report Salary slipSalary slip Photographs depicting injury sustainedPhotographs depicting injury sustained

9. General Takaful Claims The general procedures for claim applicable to all classes of general takaful plan is as follows :The general procedures for claim applicable to all classes of general takaful plan is as follows : Notice of claim Notice of claim Make a police report Make a police report Proof of loss Proof of loss Investigation Investigation Settlement of a claim Settlement of a claim

10. General Takaful Claims The general procedures for claim applicable to all classes of general takaful plan is as follows : The general procedures for claim applicable to all classes of general takaful plan is as follows : Notice of claimNotice of claim Make a police reportMake a police report Proof of lossProof of loss InvestigationInvestigation Settlement of a claimSettlement of a claim

11. General Motor Takaful Claims Claims under motor takaful may arise under: Claims under motor takaful may arise under: Own Damage ClaimsOwn Damage Claims Partial Loss Partial Loss Total Loss Total Loss Theft Theft Windscreen Windscreen Lialbility to Third PartyLialbility to Third Party Damage to property belonging to third party Damage to property belonging to third party Death and/ or bodily injury to third party Death and/ or bodily injury to third party

12. General Motor Takaful Claims Processing of claims for Partial/Total Loss Processing of claims for Partial/Total Loss Documents to be submitted are:Documents to be submitted are: Claim form Claim form Police report Police report Estimate of repairs Estimate of repairs Copies of identification card and driving license Copies of identification card and driving license Copies of the registration card and road tax of the vehicle Copies of the registration card and road tax of the vehicle

13. General Motor Takaful Claims Appointment of adjusterAppointment of adjuster ApprovalApproval ReinspectionReinspection DischargeDischarge PaymentPayment

14. General Motor Takaful Claims Processing of Claims for windscreen Processing of Claims for windscreen -claim form -Copy of the participant’s identification card; -Photographs of the damaged windscreen; -The bill for replacement of the damaged windscreen

15. General Motor Takaful Claims Third Party Third Party -operator liable only to indemnify against liability to third party ; -liability to third party should be viewed strictly from the provision of the law; -offer for settlement made directly to claimant; -proper discharge must be obtained from the claimant ; - liability of the participant can only be determined by the court ; - panel lawyers can be appointed if deemed necessary - panel lawyers can be appointed if deemed necessary

16. Loss Adjusters Investigates and evaluates damages independently Investigates and evaluates damages independently Assess liability and quantum payable by the takaful operator Assess liability and quantum payable by the takaful operator Communicating with participants, claimants, beneficiaries, public authorities and others such as witnesses. Communicating with participants, claimants, beneficiaries, public authorities and others such as witnesses. Negotiate with contractors on time and cost of repairs for the purpose of making an offer of settlement to the participant. Negotiate with contractors on time and cost of repairs for the purpose of making an offer of settlement to the participant. Protect the interest of the takaful fund when dealing with claimants Protect the interest of the takaful fund when dealing with claimants

17. Claims Dispute When a dispute arises, it may be resolved through the following channels : Negotiation – ex gratia Litigation Arbitration Mediation Financial Mediation Bureau

18. End Thank you