insurance-fraudThe SAICB has developed the database to accommodate the requirements of the SAIA Code of Conduct, and the first requests from member companies to vet new associates have already been received and processed.

The initial vetting requests have already proven the worth of the process and the SAICB anticipates that this will become a valuable tool for insurers to ensure that the associates being appointed have a reliable reputation in the industry.

The following clause on page 16 of the SAIA Code of Conduct refers:

11. Fraud and improper conduct

Members of the SAIA are unequivocally opposed to fraud and improper conduct, and will do everything in their power to identify, verify, investigate and prevent such behaviour.

SAIA members will follow the following standards in this regard:

11.1 Insurers

All insurers are expected to participate in combating fraud and improper conduct.
Should an insurer cancel a contract with an associate due to the fact that that associate was found to have acted fraudulently or in an improper manner, the following procedure will be followed by the insurer:

• The insurer will inform the customers of the associate about the cancellation of the contract between the insurer and the associate, as well of the options available to the customers including retaining their current policies with the insurer directly or through another associate, or moving their business with the Associate;
• Inform the South African Insurance Crime Bureau (SAICB) of the cancellation of the contract with the associate and the reason for it;

11.1.3 Should an insurer be approached by an associate with a book of business, the insurer will establish with the SAICB

• whether another insurer has notified it about the cancellation of a contract with that particular associate due to the fact that that associate was found to have acted fraudulently or in an improper manner.
• Should the insurer find out that that associate had in fact been referred to the SAICB, the insurer should not accept business through that particular associate.

11.2 Insurers’ employees and associates

11.2.1 In dealing with policyholders, there should be a presumption of innocence until the facts indicate otherwise.

11.2.2 Investigators, loss adjusters and assessors will treat policyholders with respect at all times and will not harass, intimidate or threaten policyholders at any time during an investigation. Insurers will include this provision in their third party supplier agreements.

11.2.3 Insurers will request access to relevant information only when investigating potential insurance fraud, and will treat any personal information in terms of the relevant privacy laws.

11.2.4 When sharing information regarding insurance fraud, such information will only be shared for the purpose of combating crime as it is highly prejudicial.

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