What is a reportable circumstance and what is a claim?

A reportable circumstance is any occasion when the Insured first becomes aware of any of the following:

  • an intimation of a possible claim for damages, including correspondence intimating that the Insured was at fault in relation to performing any service or is liable for costs incurred or losses suffered by a third party; or
  • the intention of any person likely to lodge a claim against the Insured; or
  • any fact, circumstance, incident or event which could reasonably be anticipated to give rise to a claim at any future date or  time; or
  • a complaint against the Insured from the Health Professions Council of South Africa (“the HPCSA”) or any other statutory body governing the conduct of the Insured’s profession; or
  • the intention or threat by any person to make a complaint against the Insured; or
  • a subpoena  to attend at an inquiry or inquest proceedings relating
  • the death of a patient who was under the Insured’s care and/or was or is being treated by the Insured; or
  • that criminal charges will be or have been laid against the Insured arising out of the Insured’s rendering of professional services;
  • any fact or incident which would lead the Insured to believe that a claim may be made against it which would be covered

A Claim is actual notice in the form of any of the following:

  • any notice of demand for compensation made by a third party against the Insured; or
  • any statement of claim, summons, writ, application or other originating legal or arbitral process, or third party notice served
  • upon the Insured which contains a demand or prayer for compensation made by a third party against the Insured; or
  • any notification of penalty or intention to levy a penalty against the Insured.

In all cases, the Insured shall as soon as possible but in any event not later than 30 (thirty) days give notice thereof to the Insurer in writing.

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