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3.2.6 Claims

Effective from Jan 31 2025 - Jan 30 2025
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Banks which have strong internal audit and investigative functions and are able to properly document losses, generally experience little difficulty in getting claims paid in a prompt and satisfactory manner.

As a very general measure, insurers typically pay about 75% of the claimed value for about 90% of the items for which legitimate claims are submitted. Therefore, if an insured submitted ten legitimate claims totaling SR 1 million in a year, they could reasonably expect to receive between SR 600,000 and SR 800,000 in compensation less deductibles. It is extremely important that the bank clearly understand what is covered and more importantly what is not covered under the insurance contract. The filing of frivolous claims for which no coverage was contemplated in the policy not only creates extra work for the banks but also serves to antagonize both brokers and underwriters. However, it should be noted that claim payment is almost entirely a function of the quality of claims. Fully documented paid in full by underwriters, while poorly documented claims are, at best settled for a negotiated amount below that claimed or denied completely. In addition the quality of claims documentation and processing by both the bank and its broker directly effects the speed with which claims are settled. If underwriters must repeatedly request additional documentation in order to reach a settlement decision, claims processing becomes a drawn out and cumbersome process. In addition, if a bank has inadequate audit trails and investigative documentation procedures it will be necessary to secure the services of outside accountants, attorneys' or loss surveyors to conduct a proper investigation and generate claim documentation which will be acceptable to the underwriter. This process is both costly and time consuming and materially erodes whatever financial settlement is ultimately reached with the insurer.

It should also be noted that nowhere in any BBB/FIB or ECC contract a condition precedent to liability exists which requires a court judgment against a perpetrator to prove a claim. In fact, no condition precedent to liability exists in the insurance contract that incidents of either internal or external fraud be reported to the police.

Although this may be a legal/regulatory requirement and is certainly a prudent action on the part of the bank.