Thari ya Baruti Terms & Conditions

57 13.2.2 A Claim for Benefits may be repudiated by the Insurer if a Claim is made after the 12 (twelve) Month period indicated in clause 13.2.1 of this Part I; or in the event that a Claim is not supported with all the relevant Claim Documents. 13.2.3 Claims for Benefits must be submitted to the Insurer (or its duly appointed administrator, Kganya Insurance Administrators) as follows: 13.2.3.1 at one of the Kganya Insurance Administrator’s Service Centres, the details of which can be found on the website of Kganya Insurance Administrators at https://mykganya.com ; or 13.2.3.2 any designated office of the Insurer. 13.3 Consideration of Claims 13.3.1 If the Insurer disputes or rejects a Claim, the Insurer will provide the Beneficiary with a notice setting out the reasons for the decision. 13.3.2 In such event, the Beneficiary may, within 90 (ninety) days from the date of receipt of the notice, make representations to the Insurer regarding the decision. 13.3.3 If the Beneficiary fails to make such representations, the Insurer shall not be liable to pay a Claim, and the Insurer’s liability to pay a Claim will be extinguished. 13.3.4 If the Beneficiary makes representations to the Insurer, the Insurer shall, within 45 (forty-five) days of receiving such representations, inform the Beneficiary of its decision. 13.3.5 After receipt of the decision of the Insurer, if the Beneficiary does not, within 12 (twelve) months from the date of the happening of the Insured Event, begin legal proceedings in a competent court and prosecute such proceedings to final judgment, any liability of the Insurer shall be extinguished and no Benefits will be payable for such Claim and/or the Insured Event. 13.3.6 The 12 (twelve) month period will be suspended during the 90 (ninety) day period mentioned in clause 13.3.2, and provided further that the Beneficiary will at all times have at least 6 (six) months after the expiry of the 90 (ninety) day period to institute legal action in a court of law or to lodge a complaint with the Long-term Insurance Ombudsman. 13.4 Payment of Claims 13.4.1 Claims shall be settled by the Insurer by electronic funds transfer (“ EFT ”) into the bank account nominated by the Beneficiary upon submission of the Claim. 13.4.2 The nominated bank account must be a bank account held with a South African bank, and payment will be made in South African Rands into such bank account. 14. Amendments 14.1 Amendments to this Thari ya Baruti Pukwana ya Kganya Contract 14.1.1 The Insurer shall at all times be entitled to amend any provision of this Thari ya Baruti Pukwana ya Kganya Contract (and, for the avoidance of doubt, the Policies forming part thereof) by 31 (thirty-one) days prior written notice to the Policyholder. 14.1.2 Unless specifically provided otherwise in this Thari ya Baruti Pukwana ya Kganya Contract or indicated by the Insurer to the contrary, any amendments to the terms and conditions of this Thari ya Baruti Pukwana ya Kganya Contract which result in changes to the Benefits payable, will not affect a Claim in respect of an Insured Event occurring prior to such changes coming into effect. The Insurer will at all times consider a Claim based on the policy wording and Benefits applicable at the date of the occurrence of the Insured Event. 14.1.3 Subject to and without limitation of the Insurer’s right to cancel this Thari ya Baruti Pukwana ya Kganya Contract as set out in clause 16 of this Part I, upon the occurrence of a change in the Applicable Laws which impacts this Thari ya Baruti Pukwana ya Kganya Contract, the Insurer shall be entitled to make such amendments to this Thari ya Baruti Pukwana ya Kganya Contract as it deems necessary to ensure compliance with the change in the Applicable Laws. 14.1.4 The Insurer shall inform the Policyholder of any such change, and the effective date thereof. 14.1.5 If a provision of this Thari ya Baruti Pukwana ya Kganya Contract conflicts with any provision of the applicable insurance laws as a result of a change in the Applicable Laws, the Insurer will at all times act in accordance with the provisions of the Applicable Laws notwithstanding any express provision of this Thari ya Baruti Pukwana ya Kganya Contract to the contrary. 14.2 Changes to information included in the MPP Form and Payment Receipt Booklet 14.2.1 The Policyholder may amend any information included in the MPP Form and/or the Payment Receipt Booklet by – 14.2.1.1 completing the AMPP Form and submitting it to the Insurer’s duly appointed administrator, Kganya Insurance Administrators, or through the Church Branches; and/or 14.2.1.2 calling the call centre of the Insurer’s duly appointed administrator, Kganya Insurance Administrators. 15. Consent to disclosure of personal information 15.1 The Insurer is required by the Applicable Laws to process information (including personal information) of the Policyholder, Assured Lives and/or Beneficiaries in order to provide the cover and Benefits as set out in this Thari ya Baruti Pukwana ya Kganya Contract (“ personal information ”). 15.2 Without limitation to the provisions of clause 4 of this Part I, the Policyholder confirms that he expressly authorises the Kganya Benefits Fund Trust (and/or the administrator of the Kganya Benefits Fund Trust) to share the personal information disclosed to the Kganya Benefits Fund Trust (and/or the administrator of the Kganya Benefits Fund Trust) with the Insurer for the purposes of this Thari ya Baruti Pukwana ya Kganya Contract. 15.3 The Insurer may be required to share and collect certain personal information to assist the Insurer with the provision of services, to assess risks and/or Premiums and/or Additional Premiums and/or consider Claims, or for any other proposal or change as may be required for the purposes of this Thari ya Baruti Pukwana ya Kganya Contract. 15.4 The Insurer is limited by the applicable data protection legislation to only collect and process information that specifically relates to, and is relevant to this Thari ya Baruti Pukwana ya Kganya Contract, and the Insurer is accountable for this information. The Insurer undertakes to keep such information confidential, secure and to maintain such information only for as long as it is needed and/or prescribed in terms of the Applicable Laws, and will, at all times, comply with the applicable data protection legislation, which includes without limitation, the Protection of Personal Information Act, 4 of 2013. 15.5 The Insurer shall process, analyse and store personal information for the purposes for which it was collected, to - 15.5.1 conclude and administer this Thari ya Baruti Pukwana ya Kganya Contract, which may include underwriting; 15.5.2 allow for the collection of Premiums and Additional Premiums; 15.5.3 assess and process Claims, and do mandatory checks; 15.5.4 comply with all legal and regulatory requirements, including industry codes of conduct; 15.5.5 protect and pursue the legitimate interests of the Insurer and any third parties; 15.5.6 prevent loss or fraud;