An Insurance Claim Demand Letter is a critical document used when seeking resolution of an insurance claim in South Africa. It serves as a formal written demand to an insurance company for payment or settlement of a claim under an insurance policy. The document is typically prepared when initial claim submissions have not resulted in satisfactory settlement, or when formal documentation of the demand is required. It must comply with South African insurance legislation, including the Insurance Act 18 of 2017 and relevant consumer protection laws. The letter includes comprehensive details about the claim, policy references, incident description, quantum of loss, and supporting documentation. It often represents a final step before potential legal proceedings and must therefore be carefully drafted to establish a clear record of the demand and compliance with policy conditions.
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1. Sender's Details: Full name, address, and contact information of the claimant
2. Recipient's Details: Insurance company's name, address, and relevant department
3. Policy Reference: Insurance policy number and type of coverage
4. Claim Reference: Claim number if previously assigned
5. Incident Details: Clear description of the incident, including date, time, and location
6. Basis of Claim: Explanation of why the loss is covered under the policy
7. Quantum of Claim: Detailed breakdown of the amount claimed
8. Previous Correspondence: Reference to any previous communication regarding the claim
9. Formal Demand: Clear statement of the amount demanded and payment terms
10. Compliance Statement: Statement confirming compliance with policy conditions and claim procedures
11. Closing and Deadline: Response deadline and consequences of non-payment
1. Legal Representative Details: Include when the letter is sent by a legal representative on behalf of the claimant
2. Breach Notice: Include when the insurer has breached specific policy terms or regulatory requirements
3. Settlement Proposal: Include when offering specific settlement terms or payment arrangements
4. Dispute History: Include when there has been a significant dispute history that needs addressing
5. Interest Calculation: Include when claiming interest on delayed payment
6. Without Prejudice: Include when the letter contains settlement negotiations
1. Schedule A - Incident Documentation: Police reports, accident reports, or incident records
2. Schedule B - Proof of Loss: Photographs, videos, or other evidence of damage/loss
3. Schedule C - Financial Documentation: Invoices, quotes, receipts, or valuations supporting the claim amount
4. Schedule D - Medical Reports: For claims involving personal injury or medical expenses
5. Schedule E - Expert Reports: Professional assessments or expert opinions supporting the claim
6. Schedule F - Communication Log: Chronological record of all relevant correspondence with the insurer
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