MOTOR INSURANCE

CLAIMS
Motor Claims Handling Procedures
1. a “Notification of Motor Accident Form”
shall be completed.
Please refer to Claims Notification
Form
 2 UNDERWRITING AND
ACCOUNTS VERIFICATION
• These form is in soft copy available in
Agent training folder.
• Underwriting verification and Accounts
Verification forms.
• Claims officer shall insert the information
into the system and validates existence
of cover
 3.ENTRY IN RECORDS
• The details of the claim and the policy
cover shall be recorded in the standard
Motor Register Book
• A claim file shall be opened by filling all
particulars shown on it.
 4.CLAIM PROCESSING
• Traffic Policy Report and Travel Advance
request
• Assigns an Inspector immediately to
handle the case whenever the
claim necessitates his attendance.
 Inspector Report

• Towing Service Requisition Form

• The Inspector who has been assigned to

follow up a claim shall give a detailed
report using the “Motor Accident
inspection Report.”
 Inspector Report
• Insured or his/her Agent or Inspector as
the case may be shall hand over
damaged vehicles necessitating a towing
service to a tower using “Damaged
Vehicles handing over Form”
 Inspector Report
• The assigned Inspector shall hand over
the damaged vehicle to the Recovery
Department on the date of its arrival to the
Recovery Department against signature of
handing and taking over document. And
present the copy to claims department
 External assessment by surveyor
• The assigned surveyor after the damaged
vehicle reached in Recovery compound.
Should conduct preliminary assessment

• List of parts to be repaired and changed shall

be prepared and signed by the surveyor and
posted on the vehicle and copies of lists shall
be sent to the claims department.
 TENDER HANDLING
• As soon as list of parts to be changed or
repaired are posted on the damaged
vehicle the claims department shall
immediately invite garages to submit
their bids for body two repair.
• The Client will be allowed to nominate
two garages
 TENDER HANDLING
• The assigned Surveyor shall prepare and
submit body assessment report .The
report should include list of damaged
body parts to be replaced, repaired, cost
of parts, labor charges, salvage and pre
accident values and whether the vehicle
can be economically repaired and also
indicate time required fro repairing.
 TENDER HANDLING
• The original body and mechanical damage
assessment reports shall be deposited in
the bid box maintained at claims
department after being registered and
rubber stamped by the claims manger
secretary
 TENDER HANDLING
• The garages shall submit their bids in
sealed enveloped within five days after
receipt of invitation.
• All sealed envelopes shall be opened
• Bids analysis
• bids committee approval form
 TENDER HANDLING
If the Vehicle is repairable, the claims department,
• Shall agree with the insured on any
contribution and any other costs to be borne
by him.
• Shall give work order to the winner garage on
contract basis for both body repair works within
two days, and
• Sends a copy of the work order to the
Recovery Department so as the Department
can hand over the vehicle to the repairing
garage.
 satisfaction note
• Upon completion of repair work, the claims
department shall issue a vehicle release
order after the garage submitted a
satisfaction note dully signed by the
insured or his/her legal representatives
together with invoices
 TENDER HANDLING
• Insured with their own garages
• Private organizations (other than
vehicle repairer garages) and
government organizations
 Third party Claims
• Knock for knock”
• Own damage claims on accidents that
happened out of the traffic road.
• Third party bodily injury claims outside the
scope of the Civil Code Act 2081/2 and
2086/2, which states
 Third party Claims
• Civil code 2081/2
He shall not be liable where he proves that at
the time when the damage was caused the
machine or vehicle had been stolen from him
Civil Code 2086/2
They shall be relieved of their liability, entirely
or in part, only where the damage is due
solely or partly to the fault of the victim.
 Mechanical damage
• Mechanical damage assessment shall be
made in the garage by the assigned
surveyor.
 Total loss claims

• “Total loss of damaged vehicle shall be

declared if it is uneconomical to repair; taking
the following points into consideration.
 When the vehicle is totally destroyed/lost/due
to insured peril.
 When the repair cost is equal or more than the
sum insured.
 When the repair cost is uneconomical:-
 Total loss claims
• When the estimated repair cost is equal or
more than 75% of the sum insured of the
vehicle. In order to determine whether to
declare a total loss it shall require to know
the salvage value of the vehicle
• If the estimated total repair cost exceeds
the sum insured less the salvage value,
then the vehicle shall be declared as
constructive total loss
 Total loss documents
• The owner-ship title certificate
• Power of attorney confirming that the
salvages can be disposed of or
transferred
• Inland Revenue and Road Transport
Authority tax clearance certificate, I n
respect of vehicle for commercial use
only
 Total loss documents
• Customs declaration in respect of
diplomatic vehicle
• Clearance letter from Toad Transport
Authority in respect of private Vehicles
and Taxis
• If the total loss vehicle is imported on
duty free additional steps have to be
followed to get the legal right to dispose
the salvage.
 Bank interest
Claims with a Bank interest
in case of total loss shall be
paid in cash to the insured
only when a written consent
is obtained from the bank.
 REPLACED PARTS
• All body and mechanical parts for which
new substitution are to be made shall be
handed –over by the garage during the
assessment to the Surveyor who shall
immediately pass them to the recovery
Department on receipt of two copies of the
‘ Replaced parts Delivery Slip’
 CONTRIBUTION
• Betterment contribution

• Cylinder
If used for 10-15 years 10
• - Used over 15 years 20
• - Already welded or laminated 20
• 3) Crank Shaft Size
• 010 10
• 020 20
• 030 30
• 040 40
• 050 50
 EXCESS /RECOVERIES
• Should be collectd
 THIRD PARTY CLAIMS
HANDLING
• THIRD PARTY PROPERTY

 THIRD PARTY BODLY INJURY

The law is not clear on the subject of

assessing third party’s claim for bodily
injuries. Customs equity and common
sense play therefore a very important part
in dealing with these kinds of claims
 Bodily injuries
• Third party bodily injuries are handled in
accordance with article 2090 to 2123 of
the Ethiopian Civil Code
• Compensation payable in respect of fatal
injury shall be supported by
» Post-mortem certificate (whenever possible).
» Police or equivalent report.

Court certificate of legal heirs

 Compensation for permanent
disability shall be supported by :
 Medical Board’s Certificate (whenever
possible) and
• Policy or equivalent report.
• Temporary disability benefits shall be paid on
receipt of a medical certificate ascertaining the
period of incapacity to work as a result of the
injury suffered in the accident and the amount
(benefit) is calculated on the basis of the
earnings foregone of the injured person
 THIRD PARTY CLAIAMS
FOLLOW-UP
• Third party Recovery Register Book”
 Recovery from a liable Third party
Collection of recovery from a liable Third
party, where the insured vehicle is
declared as total loss, shall be handled
as follows
 Recover shall be collected after the
salvage is sold
 Recovery from a liable Third party
• If the value obtained from, the sale of the
salvage is equal or greater than the sum
insured, of the vehicle, then there will be
no collection of recovery from the liable
Third party
 Recovery from a liable Third party
• If the value obtained from the sale of the
salvage is less than the sum insured, of
the vehicle, then the difference shall be
collected from the liable Third party.
• The liable Third party shall not
retain/obtain the salvage of the vehicle
except by participating in the public
auction of the salvage. END