| i) | An insurer must, where an agreement has been entered into with a person for the rendering of services as independent intermediary in connection with the insurance products of that insurer, furnish the person with a written copy, setting out the terms and conditions thereof: Provided that an insurer may on or after the commencement date only enter into such an agreement if the person has been issued with a licence for the rendering of intermediary services in terms of section 8 of the FAlS Act, or is where lawfully required a representative as contemplated in that Act of any such licensee. |
| ii) | An agreement referred to in subparagraph (i) which has, been entered into under Rule 10.1 (a) of the previous Rules, as it existed prior to the commencement date, lapses on that date 90 days after that date if the relevant person is not on that date such a licensee or such a representative. |
| b) | Any such agreement also lapses- |
| i) | on any date on which the agreement is lawfully terminated by the parties, irrespective of whether the termination has been mutually agreed upon, or is effected by any one party by notice to the other: Provided that any such lapsing shall not be effective unless- |
| aa) | all policyholders holding current policies entered into by the insurer through the relevant person referred to in paragraph (a)(i) have been given prior written notice of the termination in accordance with Rule 7.3(b) (which apply with the necessary changes) by either the insurer or the person involved, or both; and |
| bb) | both insurer and the relevant person are beforehand satisfied that all reasonable steps have been taken for such information to reach all such policyholders; |
| aa) | on the date when a licence held by the person concerned becomes inoperative by virtue of the application to the person as licensee of any provision of section 9 of the FAlS Act relating to provisional or final suspension of the relevant licence, section 10 of that Act relating to withdrawal of the licence or section 11 of that Act relating to lapsing of the licence; or |
| bb) | in the case of any such person acting as a representative contemplated in the FAlS Act, on the date on which the mandate or authority granted in terms of the FAlS Act to the representative by the licensee concerned, is lawfully terminated, or any such representative becomes debarred by virtue of section 14 of the FAlS Act to act as a representative. |
| c) | An insurance party involved, shall ensure that in the case of any lapsing contemplated in paragraph (a)(ii) or (b)(ii) all policyholders involved- |
| i) | are without delay informed of the lapsing in accordance with paragraph (b)(i)(aa) and (bb), which apply with the necessary changes; and |
| ii) | are so informed on new arrangements made by the insurer whether for the mandating or authorising of another person as intermediary or for servicing the relevant policies itself. |
| d) | An insurer must, within a reasonable time after being requested to do so, provide any person with whom an agreement contemplated in paragraph (a) of this Rule has been entered into, with all information about the insurer or its policies reasonably required by such person to comply with any disclosure or other requirements binding on such person by virtue of any law |
An insurance party involved
| a) | shall ensure that any debit order to be signed by a policyholder for the payment of premiums to any such party, shall not be drafted to be in favor of any other person (whether conjointly with the insurance party involved or as an alternative) but such first mentioned party; |
| b) | shall not unilaterally terminate any current debit order signed by a policyholder without having informed the policyholder in writing of the intention so to terminate the debit order at least 30 days before the effective date of such envisaged termination. |
| 2) | Unilateral termination of policies |
| a) | An insurer shall not unilaterally terminate any policy without giving notice as set out: in paragraph (b) of this Rule. |
| b) | The insurer may give notice either- |
| i) | direct to the policyholder 30 days prior to the cancellation date: or |
| ii) | by satisfying itself that notice has been given in accordance with subparagraph (i) to the policyholder by the independent intermediary; or |
| iii) | if compliance with subparagraphs (i) or (ii) is not possible, by publication of such notice in two editions of a newspaper circulating in all areas in which it is reasonably believed that relevant policyholders reside, and by forwarding a copy of such notice to the Authority prior to publication. |
| 3) | Decisions relating to claims and time limitation provisions for the institution of legal claims |
| a) | An insurer must accept, reject or dispute a claim or the quantum of a claim for a benefit under a policy within a reasonable period after receipt of a claim. |
| b) | An insurer must within 10 days of taking any decision referred to in paragraph (a), in writing, notify the policyholder of its decision. |
| c) | If the insurer rejects or disputes a claim or the quantum of a claim, the notice referred to in paragraph (b) must inform the policyholder - |
| i) | of the reasons for the decision; |
| ii) | that the policyholder may within a period of not less than 90 days after the date of receipt of the notice make representations to the relevant insurer in respect of the decision; |
| iii) | of the right to lodge a complaint under the Financial Services Ombud Schemes Act, 2004 (Act No 37 of 2004) and the relevant provisions of the Act relating to the lodging of such a complaint, in plain understandable language; |
| iv) | in the event that the relevant policy contains a time limitation provision for the institution of legal action, of that provision and the implications of that provision for the policyholder in an easily understood manner; and |
| v) | in the event that the relevant policy does not contain a time limitation provision for the institution of legal action, of the prescription period that will apply in terms of the Prescription Act 1969 (Act No. 68 of 1969) and the implications of that provision for the policyholder in an easily understood manner. |
| d) | If a claim is rejected or disputed, or a quantum is disputed as contemplated in paragraph (a) on behalf of an insurer by a person other than the insurer, such other person must provide the notice contemplated in paragraph (b) and include in that notice in addition to the information referred to in paragraph (c), the name and contact details of the insurer and a statement that any recourse or enquiries must be directed directly to that insurer. |
| e) | If the policyholder makes representations to the relevant insurer in accordance with paragraph (c)(ii) the insurer must within 45 days of receipt of the representation, in writing, notify the policyholder of its decision to accept, reject or dispute the claim or the quantum of a claim for a benefit under a policy. |
| f) | If the insurer, despite the representations of the policyholder, confirms the decision to reject or dispute the claim or the quantum of a claim, the notice referred to in paragraph (e) must- |
| i) | inform the policyholder of the reasons for the decision; |
| ii) | include the facts that informed the decision; and |
| iii) | include the information referred to in paragraph (c)(iii) to (v). |
| g) | Any time limitation provision for the institution of legal action that may be provided for in a policy entered into before 1 January 2011 may not include the period referred to in (c)(ii) in the calculation of the time limitation period. |
| h) | Any time limitation provision for the institution of legal action that may be provided for in a policy entered into on or after 1 January 2011- |
| i) | may not include the period referred to in (c)(ii) in the calculation of the time limitation period; and |
| ii) | must provide for a period of not less than 6 months after the expiry of the period referred to in paragraph (c)(ii) for the institution of legal action. |
| i) | Despite the expiry of the period allowed for the institution of legal action in a time limitation clause provided for in a policy entered into before or after 1 January 2011, a policyholder may request the court to condone non-compliance with the clause if the court is satisfied, among other things, that good cause exists for the failure to institute legal proceedings and that the clause is unfair to the policyholder. |
| j) | For the purposes of section 12(1) of the Prescription Act, 1969 (Act No. 68 of 1969) a debt is due after the expiry of the period referred to in paragraph (c)(ii). |
An insurer shall ensure that a policy contains a provision for a period of grace for the payment of premiums of not less than 15 days after the relevant due date: Provided that in the case of a monthly policy, such provision must apply with effect from the second month of the currency of the policy.
| 5) | Undersigning of blank or uncompleted forms |
No insurance party involved may require, permit or allow a policyholder to sign any blank or partially completed form necessary for the purpose of entering into a policy, where another person will be required, permitted or allowed to fill in other required detail, or enter into any policy where any such lrr1derlining and providing of detail have occurred.
