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Article 15 General Provisions
Effective from - Jul 21 2020
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1. Scope of Coverage:
The Insurer shall compensate the beneficiary for loss or damage to the Motor Vehicle, including any installed accessories, occurring due to any incident, including fire, theft or damage resulting from lightening or natural disasters such as floods or hailstones, according to the Policy conditions provided below.
2.Maximum Indemnity Limit:
a. Partial Loss: The maximum indemnity limit in case of Partial Loss or Damage is the cost of reinstatement of the Motor Vehicle, in addition to the costs of transportation and storage, after calculating the Deductible amount and the depreciation rate if applicable according to the conditions stated in the Policy, and this amount shall be determined by entities licensed to conduct vehicle damage assessments.
b. Total Loss: The Insurer’s maximum liability limit in case of Total Loss shall not exceed the Sum Insured for the Motor Vehicle. The Motor Vehicle is deemed as Total Loss or damaged if the damage assessment shows that the needed repairs are economically or technically infeasible, provided that such assessment is conducted by entities licensed to conduct vehicle damage assessments.
3. Deductible:
a- In the event of Partial Loss or Damage to the Motor Vehicle the Insurer may charge the Deductible amount specified in the Policy Schedule for each Claim.
b- The Insurer’s liability starts after the Deductible has been exhausted, and this is only applicable to damages or losses occurring to the insured Motor Vehicle, and it does not apply on claims arising from civil liability coverage against third party.
c- The First Beneficiary shall not be charged a Deductible if the Lessee or the Driver were not held liable for the Accident, according to the report prepared by the entity attending the Accident scene.
d- In case the First Beneficiary or the Driver is held partially liable for the Accident, the percentage of Deductible amount shall be calculated as per the percentage of liability accounted for by the Lessee or the Driver regarding the Accident only.
e- Under no circumstance shall the Deductible be multiplied within this Policy for a single motor Accident.
4. Storage and Transportation:
The Insurer shall pay the expenses incurred by the Insureds when transporting the damaged Motor Vehicle, due to an Accident covered under the Policy, to a safe location, auto repair shop, certified dealership, or to an assessment center in the case the vehicle was immobile. Such expenses will be limited to a maximum of SAR (500) within the city and SAR (1,000) outside the city; provided that the transportation receipt is submitted when filing the Claim.
6. Claim Settlement Procedures:
a- Either the First or the Second Beneficiary may file a Claim request to the Insurer upon the occurrence of loss or damage covered under the Policy. The Insurer shall provide the Claimant, within (3) business days, with a notice acknowledging receipt of the Claim and informing them of any missing documents. The Insurer may also appoint an assessor or loss adjuster, if necessary, within a period not exceeding (3) business days from receiving the Claim completed with all documents, provided that the Insurer informs the Claimant of whether the Claim is accepted or rejected, within (10) business days from the date of filing the Claim completed with all documents.
b- If the Claim is accepted and deemed to be Partial Loss, the Insurer shall approve repairing the insured Motor Vehicle at the respective certified dealership or the certified auto repair shops approved by the Insurer (as specified in the Policy Schedule) within (5) business days, ensuring that the First Beneficiary receives the Motor Vehicle after it has been reinstated to its former condition before the loss or damage. The Insurer shall also provide details regarding the due indemnity process and what does it cover (the amount of spare parts and labor charges).
c- If the insured Motor Vehicle is deemed to be Total Loss, the Insureds shall compensate the Second Beneficiary with the Sum Insured specified in the Policy Schedule - after calculating the Deductible, if any - and inform the First Beneficiary of the amount indemnified to the Second Beneficiary via a reliable communication means. The Insurer shall settle the Claim sustained under this Policy with integrity and fairness, without any compromises, and within a maximum period of (10) business days from the date of the Claim completed with all documents. The Second Beneficiary shall deliver the Motor Vehicle wreckage to the Insurer.
d-In the event of damage or loss of the Motor Vehicle caused by a third party, The Insurer shall compensate beneficiaries in
accordance to these Rules. The Insurer has the right of recovery against the Insurer of the third party whom caused the accident.
e- The Insurer shall prioritize the First Beneficiary in purchasing the insured Motor Vehicle wreckage when its loss or damage is deemed as economically Total Loss, according to the value determined by the authorized entity in assessing the Motor Vehicle after the occurrence of the damage.
f- In case of Motor Vehicle theft, the Insureds or any of them shall report to the competent authorities and the Insurer promptly, and the Claim shall only be accepted after a period of (60) days from the date of submission of such report.
g- If an Insurer does not issue the necessary approval for repairing the Motor Vehicle or settling the Claim within the prescribed period without a legal justification, both beneficiaries - after filing a complaint to the Insurer- are entitled to submit a complaint against the Insurer via SAMACares website (www.Samacares.com) or with the Committees for Resolution of Insurance Disputes and Violations, so as to compel the Insurer to settle the Claim and compensate such beneficiaries for any costs incurred as a result of their inability to use the Motor Vehicle due to the Insurer's delay in settling the Claim.
h- In case of rejection of the Claim, the Insurer shall:
1.Provide the Claimant with the reasons for rejection.
2.Inform the Claimant of their right to submit a complaint at SAMACares website (www.Samacares.com) or refer their case to the Committees for Resolution of Insurance Disputes and Violations for consideration.
3. Provide the Claimant with a copy of documents related to the Claim upon their request.