SET OF RULES FOR INVESTIGATING AND RESOLVING CLAIMS – PASSPORTCARD TRAVEL INSURANCE POLICY

The set of rules stated below was intended to bring before you the method of handling and resolving claims for an insurance payout that are filed with our company, as well as to update you about your rights when filing a claim for an insurance payout. This set of rules is according to the instructions of the Commissioner of Insurance in the State of Israel.

Definitions
‘The Commissioner’s circular’
A circular that was issued by the Commissioner of Insurance, the Capital Market Department at the Ministry of Finance, no. 2016-9-9, which addresses the provisions set out below regarding the investigation and resolution of claims and dealing with public complaints.
‘Communication’
A communication of the insured to PassportCard about the manner of filing a claim or receiving information about the process of handling claims.
‘Claim’
A demand that is submitted to PassportCard for reimbursement of expenses and realization of the insured’s rights under the terms of the policy or under the provisions of the law.
‘Claim form’
A document whichdetails the insurance incident, its circumstances and additional details required by PassportCard for the purpose of investigating the claim.
‘Insurance policy’
A travel insurance policy that was issued by PassportCard through ‘David Shield Insurance Company Ltd.’ and that was bought by the insured accordingly.
‘Insured’
As defined in the insurance policy.

The process of investigating and resolving claims
A. A communication of an insured regarding the filing of a claim
An insured who sends a communication to PassportCard in connection with the manner of filing a claim will receive the following details/documents:
1. An explanation about the method of filing the claim.
2. This set of rules or, a referral to the to appropriate place on the Company’s website.
3. The Claim form, or, a referral to to self service area on the Company’s website, and all the information and documents required for a claim – a complete claim form, receipts for payments that were made and any detail that is required for the purposes of investigating an insured’s claim.

B. Documents and Information for investigation of a claim
1. Upon receipt of a claim, the details of the claim will be entered into the system and the insured will receive, as soon as possible, a letter or notice that includes at least the following details:
a. This set of rules or a reference to the appropriate place on the Company’s website.
b. Full details of the claim that was received, including the dates of receiving the claim, the date of receiving the service or the occurrence of the insurance incident, the name of the service provider, details of the insured and any other information, insofar as there is any, about the claim documents that were sent by the insured.
c. Details of all the documents that were received (for example, a claim form, receipt from a medical service provider and its details, medical report, police report, confirmation from an air carrier, etc.)
d. If information or documents are missing, the insured will receive complete details of the information and documents that are missing in order to continue investigating the claim.
e. Notice about the prescription period.
2. If a claim is received in which the insured is not required to provide additional details and the claim is approved for payment, the insured shall receive a detailed payment notice will be sent to the insured accordingly.
3. If a claim is received in which the insured is not required to provide additional details, and the claim is rejected, the insured will receive a rejection notice according to the provisions stated below regarding notice of the rejection of a claim.

C. Claim with missing documents
1. If the insured sent a claim and it is clear to PassportCard that it lacks additional documents, PassportCard will send the insured a demand to provide the missing documents and full details of the missing documents, within 14 days of the date of receiving the claim.
2. This request will be accompanied by a notice of the prescription period.
3. If the insured does not respond to the first notice regarding missing documents, an additional notice will be sent after 60 days. If the insured does not respond to the second notice either, an additional notice will be sent after an additional 60 days.
4. If the insured does not respond to two notices about missing documents that were sent to him as stated in section C(3) PassportCard may stop sending additional notices, provided that the second notice stated that it was the last notice.
5. If the insured applied to the courts regarding the claim, PassportCard is permitted to stop sending investigation notices and notices demanding additional documents.
6. When all the documents required to investigate the claim have been received, the insured should be notified of the results of processing the claim within 30 days of the day on which all the documents were received.

D. Notice of further investigation
1. If the insurer needs to make a further investigation of a certain claim, a detailed notice in writing should be delivered to the insured, stating the reasons why further investigation is required.
2. If a further investigation requires additional documents (from the insured or a third party), details should be given of the information that is required in the notice stated in section D1 above.

E. Notice of payment of a claim
1. If it is decided to pay a claim or to pay it in part, a suitable notice will be given to the insured that will include all the components of the payment and at least the original amount of the claim, the amount that was approved for payment, details of deductibles, deductions for cover ceilings, etc.
a. In a notice of partial payment (a part of the claim is paid, and a part is rejected):
1. For the part that is paid, PassportCard should act according to section E1 above.
2. For the part that is not paid, PassportCard should issue a detailed notice rejecting payment according to the provisions below regarding rejecting a claim.
b. Every notice will include a paragraph giving details of the insured’s appeal possibilities within the framework of the insurance company (such as an appeal to the manager of the claims department, a medical manager, the public complaints officer), and the insured’s right to appeal to outside parties (applying to the courts or the public complaints commissioner at the office of the Commissioner of Insurance).

F. Notice of rejection of a claim
1. If it is decided to reject a claim, PassportCard should issue to the insured a detailed letter that includes all the reasons for the rejection, including the relevant terms of the policy (including specific underwriting terms), the provisions of the law on which the rejection is based or any other reason that justifies the rejection of the claim.
2. It is permitted to raise additional reasons only if the initial rejection notice is based on a claim of prescription or the invalidity of the policy. Moreover, it is permitted to raise additional reasons if it transpires that the insurance company or PassportCard did not know or should not have known about these reasons at the time of sending the initial notice.
3. Any notice will include a paragraph that gives details of the insured’s appeal possibilities within the framework of the insurance company (such as the manager of the customer service team, the Vice-President of Customer Service or the public complaints officer of PassportCard), and the insured’s right to appeal to outside parties (applying to courts or the public complaints commissioner at the office of the Commissioner of Insurance).

G. Settlement notice or payment beyond the strict letter of the law
If a decision is made to pay a claim in a settlement, the following details will be given to the insured:
1. The settlement offer that is made will be in writing and a reasonable time will be given to the insured to study the offer (14 days).
2. The settlement offer will include at least all the following details: a description of the insurance incidence, the reasons justifying a settlement, the payment components that are not in dispute, if there are any, and the amount determined in the settlement.
3. A settlement will only be approved after the insured approved it in writing.
4. A payment beyond the strict letter of the law does not require the insured’s approval unless it is a partial payment that has the nature of a settlement.
5. If the settlement is approved and a payment notice is issued, PassportCard should act according to the rules in section E regarding payment of a claim.

H. Notice regarding the prescription of a claim
1. Each payment notice, partial payment notice, rejection notice and first follow-up notice will include a paragraph indicating in a special emphasis the period of limitation of the claim in accordance with the relevant provisions of the law, and it will also be noted that the filing of the claim to PassportCard does not stop the prescription period and that only filing a lawsuit in court stops the prescription priod.

2. Any notice that is sent to an insured during the last year before the end of the prescription period of a certain claim will include details of the claim that is about to become prescribed (even if the notice does not relate to that claim) and it will include details of the claim, such as the date on which the insurance incident occurred and the prescription date.
3. A notice as stated in section 2 will include a paragraph that states that the prescription period began to run on the date when the insurance incident began.
4. If a prescription notice is not sent as stated in clauses H2 and H3 above, the period in which the notices were not sent will not be counted for the purposes of prescription, but only from the moment when the conditions stated in sections H2 and H3 are fulfilled, and this is only during the last year of the prescription period.

I. Investigation of a claim through an expert
1. If PassportCard finds that for the purpose of resolving the claim there is a need for a relevant expert, it will notify the insured of any use of an expert, and if necessary, it will allow and tell the insured that he has the right to bring an expert opinion of his own.
2. The use of legal advice or an investigator who investigates details of a claim is not regarded as the use of experts and no notice to the insured as aforesaid is required.
3. An expert can be an external one or an employee of PassportCard or the insurance company.
4. The activity of an expert may be based on existing information or a personal meeting with the insured, depending on the circumstances.
5. An expert opinion will give reasons and include all the relevant details about the expert, including his professional, education, etc.
6. If a decision is made about a claim on the basis of an expert opinion, the insured will receive, together with the decision, the expert’s opinion and details of all the documents on which the expert relied.
7. A privileged opinion will not be delivered to the insured. However, PassportCard or the insurance company should deliver to the insured a letter that gives the reasons why in their opinion the opinion is privileged.

J. Subrogation and third-party rights
1. If PassportCard decided to sue a third party by virtue of subrogation, a letter should be sent to the insured, stating the intentions of PassportCard, with all the details of the claim and the third parties.
2. Upon receipt of the subrogation decision (including a judgment, arbitration or settlement), a copy of the decision should be sent to the insured within 14 business days.
3. If the insured has a right of claim, PassportCard will notify the insured of this right.
4. PassportCard or the insurance company do not represent the insured or owe any duty of advice to the insured.

K. Giving replies in writing
A reply should be made in writing to every written communication of an insured according to the circumstances of the case, and in any case no later than 30 days from the date of the communication.

L. Giving copies
1. If an insured requests a copy of the policy, the copy will be sent to him within 14 days of the date of the request.
2. An insured may receive copies of every document in his file, documents that he signed or sent or documents that were sent to him, within 21 business days of the date of the request.

M. Keeping documents
1. Documents will be kept for seven years from the date of completing their processing.
2. All the information should be kept as long as the policy is in force and for seven years from the date on which processing deriving from the policy is completed (even after the cancellation of the policy).
3. In claims, all the full details of the claims should be kept, including documents relating to the claim that were sent by the insured or to the insured and any settlement, judgment, etc.

N. The Commissioner’s circular, these rules and an information letter for the insured about the filing of a claim are published on the company’s website at the address www.passportcard.co.il.

O. Retention of laws
In any case of a conflict between the provisions stated above and the provisions of the law, the provisions of the law have precedence.