Membership Summary:
- The purpose of your membership is for us to assist you with specific insurance claims against your insurer only in the
event of Repudiation and/or an undesirable result by your insurer pursuant to an insurance claim made by yourself
against your insurer. - Our fundamental objective is for you to be paid by your Insurer pursuant to a valid insurance claim.
- Your membership is in respect of the rendering of services by us to you and is not intended to be, nor does it purport to be an
insurance-rated product. - To be clear, your membership only applies to personal insurance claims and does not include any type of
business insurance claims. - The first monthly membership fee is in the amount of R199.00 (one hundred and ninety-nine rand) OR R299.00 (two
hundred and ninety-nine rand) in the event of adding your spouse to your membership. - Your membership shall commence upon payment of the first membership fee.
- Your membership benefits have a three-month waiting period. Only insurance claims made by yourself to your insurer
after the waiting period will be considered for our services. - Your membership fee is subject to an annual increase of 10 (ten) percent.
- Your membership benefits shall commence after a period of three full, successive monthly payments of your
membership fee. - If you require our services under this Membership Agreement, you agree sign a power of attorney authorising us, our authorised agents, or preferred lawyer to act on your behalf against your
insurer. Failure to do so will result in that specific insurance claim being excluded from the services offered in your
membership. - Should you remain a Member with us for a period of 3 (three) uninterrupted years, that is, us receiving the full membership
fee due for a period of 36 (thirty-six) consecutive months during which we do not render any services or benefits
to you in terms of your membership. You shall be entitled to payment from us of an amount equal to 10 (ten) percent of
all Membership Fees paid during the 3 (three) uninterrupted years.
Benefits of Being a Member:
- By being a member, we provide you with administrative, paralegal and legal services only in respect of insurance – related
claims against your insurer following your insurer’s finding of repudiation and/or an undesired result of your insurance
claim: - By being a member, only the following categories of specific insurance related claims forms part of Your benefits:
2.1. Long-Term Insurance:
2.1.1. Death;
2.1.2. Funeral;
2.1.3. Dread Disease; and
2.1.4. Critical Illness.
2.2. Short-Term Insurance:
2.2.1. Building;
2.2.2. Vehicle;
2.2.3. Household Contents; and
2.2.4. Personal Liability. - As part of your membership with us, you are entitled to the following services in relation to specific
repudiated/undesired result of insurance claims on behalf if the matter does not proceed to court
(pre-litigation)
3.1. Telephonic consultations in order to compile and assess all necessary information to determine prospects of success of the insurance claim;3.2. Liaising directly with your insurer in order to attempt to resolve the insurance claim internally before lodging a complaint to the applicable Ombudsman;
3.3. Gathering, compiling and preparing all relevant documentation to be submitted to the Ombudsman for Long-term Insurance, if applicable;
3.4. Gathering, compiling and preparing all relevant documentation to be submitted to the Ombudsman for Short-term Insurance, if applicable;
3.5. Submission of all complaints to the Ombudsman for Long-term Insurance, if applicable;
3.6. Submission of all complaints to the Ombudsman for Short-term Insurance, if applicable;
3.7. Representation on your behalf in all complaints before the Ombudsman for Long-term and Short-Term Insurance;
3.8. Representation on your behalf in all appeal processes before the Ombudsman for Long-term and Short-Term Insurance. - We shall provide you with insurance litigation services (court action) subject to the following:
4.1. After exhausting all remedies available to you pre-litigation, our preferred lawyer provides us with a legal opinion
and in such opinion, the prospects to litigate your insurance claim successfully in a Court of Law are sufficiently high.
For purposes of clarity, any prospect of success on or above the 60 percentiles would be considered as sufficiently
high. The litigation service shall only be available to you upon receipt of a sufficiently high prospect of success legal
opinion from our preferred lawyer.4.2. We shall provide litigation services to you in the most appropriate Court of Law in order to attempt to recover your insurance claim through our preferred lawyer.
4.3. Should you wish to instruct your own lawyer for your insurance claim, we shall not be liable for the legal costs of your lawyer. - The litigation service exclusions are fully described in your Membership Agreement.
General Terms and Conditions:
- Your membership has a three-month waiting period. Only insurance claims made by yourself after the waiting
period will be considered for our services. For purposes of clarity, should you lodge a claim against your insurer during
the waiting period, and the repudiation or an undesired result is received by your insurer after the waiting period, this
particular insurance claim shall not fall within the ambit of your membership. The insurance claim made by you as well
as the repudiation or an undesired result received by your insurer must occur after the expiry of the waiting period. - Your benefits do not include any insurance claims that occurred before the expiry of the waiting period, or any current or
pending insurance claims. - Should you elect another service provider, legal representative or attorney to assist you with an insurance claim which
forms part of your membership with us, our services will immediately cease for that particular insurance claim. - Should you have a repudiated claim or an undesired result in respect of an insurance claim, you must refer the insurance
claim to us within 30 (thirty) days of notification of such repudiation or undesired result from your insurer. Failure to
do so will result in that insurance claim being excluded from the services offered in your membership. - If you have already exhausted all remedies available to you at the applicable Ombudsman for Long-term and/or Short-term
Insurance, you must refer the insurance claim to us within 30 (thirty) days of notification of the finding/ruling of the
Ombudsman. Failure to do so will result in that insurance claim being excluded from the services offered in your
membership. - We may terminate your Membership Agreement and our services with no refund of Membership Fees if there is:
6.1. Misrepresentation, non-disclosure, or an inaccurate statement or information of a fact relevant to your insurance claim made by you, or on your behalf;
6.2. A fraudulent insurance claim.
6.3. An insurance claim occurs due to a deliberate, willful or intentional act committed by you, or with your
involvement, or anyone acting on your behalf; and
6.4. Any breach of, or non-compliance with, any condition of the Membership Agreement. - We make no guarantees in respect of the success of your insurance claim and provide no assurance that you will be
successful with your insurance claim either pre-litigation, during litigation or after litigation. - We shall best endeavor that you are paid for your insurance claim from your insurer after repudiation or undesired result,
however cannot guarantee a positive result. You will not be refunded any Membership Fees should you not achieve the
result that you had desired. - By entering into the Membership Agreement and agreeing to these terms and conditions, you agree that you understand
that we do not pay you any monies as a result of a repudiation or undesired result furnished by your insurer and shall only
provide services in order to best recover from your insurer an amount that you feel is due to you. - Our services are a non-insurance product and accordingly there are no underwriters or insurers linked to this service.
- We collect and process your personal information to enable us to provide you with services, amongst other things, and we
may share it with:
11.1. Our preferred lawyers, and other third parties to comply with our service obligations; and
11.2. Any party to whom we assign our rights under the Membership Agreement or any of our Agreements for services; - We are committed to protecting your privacy and have thus implemented appropriate measures to keep your information
complete, secure, accurate and in accordance with applicable privacy legislation. - You are entitled to:
13.1. Request the details of your personal information we have in our records;
13.2. Request the details about the recipients of your personal information; and
13.3. Request for the amendment or deletion of your personal information. - If we fail to collect unpaid Membership Fees, Your membership will be cancelled with effect from the 1st of the 1st
month that the Membership Fees was not collected; - If we have cancelled as above, and collect or receive a Membership Fee at any time after that, it amounts to entering into a new Membership Agreement.
- We can cancel your membership on 31 (thirty-one) days’ notice to you, for any other reason at our discretion. If we
inadvertently collect or receive a Membership Fee after such a cancellation, it does not amount to entering into a new
agreement and we will refund that Membership Fee. - If your membership is cancelled for any reason, our services will immediately cease, whether or not any insurance claim
is pending in either a pre-litigation stage or a litigation stage. - You may elect to cancel your membership during the first month of your membership (“Cooling-off period”). For
purposes of clarity, by way of an example, should your first Membership Fee be paid on the 15th May 2022, then you
shall have up until and including 15th June 2022 to cancel your membership, and we will refund the Membership Fees
that you have paid. - If you cancel your membership after the first month, we will not refund any membership fees you
have paid.
Your Go To Professionals.
Why Choose Claims Specialist?
Making an insurance claim is a very personal matter. It can also be incredibly stressful and time consuming. Claims Specialist shall take the time to help you at the repudiation stage.
Pietermaritzburg Address:
Block A, Town Bush Office Park, 460 Town Bush Road, Montrose, Pietermaritzburg, 3201
Durban Address:
15 Fairways avenue, Mount Edgecombe Country estate 2, Mount Edgecombe
Cape Town Address:
The Pavilion, Esplanade Road, Central Park, Century City, Cape Town, 7441
