Service Agreement

The Client appoints ClaimIQ as their authorised representative for the sole purpose of reviewing, disputing and (where necessary) escalating the specific claim(s) or hospital debt matter identified in the Client’s intake submission.

The mandate authorises ClaimIQ to:

• engage the Client’s medical scheme and its administrator in writing and telephonically about the claim;
• request further clinical information, motivation letters and codes from the treating provider (with the Client’s consent);
• prepare and submit dispute letters, PMB motivations and resubmission packs on the Client’s behalf;
• lodge and pursue an escalation to the Council for Medical Schemes (“CMS”) if the scheme’s internal dispute route is exhausted.

The mandate is limited to the specific claim, rejection or hospital debt described at intake. A new mandate is required for any additional or subsequent claim. The mandate does not authorise ClaimIQ to:

• alter the Client’s medical scheme membership, plan or beneficiaries;
• receive funds into a trust account on the Client’s behalf (recoveries are paid by the scheme directly to the Client or to the hospital / provider);
• make binding admissions or settlements without the Client’s written approval.

ClaimIQ is not a firm of attorneys. This Service Agreement is an administrative and clinical dispute mandate — it does not constitute legal representation in litigation. If the matter reaches a stage where legal representation is required (for example, review proceedings in the High Court), the Client will need to separately engage a qualifying attorney admitted in South Africa. ClaimIQ may recommend, but does not appoint, such an attorney.

The fee structure is a tiered flat fee, set by the size of the disputed claim:

• Case Review fee — flat, once-off per claim, non-refundable once work starts: the tier fee above is payable up-front so the clinical and administrative review can commence.
• No success fee, no commission, no percentage: the applicable tier fee is the complete fee ClaimIQ charges in respect of a claim.ClaimIQ takes no cut of any amount recovered from the scheme or written off by the hospital / provider — every rand goes directly to the Client.

Full detail (including when a refund of the Case Review fee is available) is set out in theRefund Policy.

The Client may revoke this mandate in writing at any time by emailingsupport@claimiq.co.za. Revocation takes effect on receipt.

Revocation does not entitle the Client to a refund of the Case Review tier fee if work has already commenced. Because ClaimIQ charges no percentage or success fee, there is no outcome-based amount that survives revocation.

The Client undertakes to:

• provide accurate identity, contact, scheme, plan, event and financial information;
• upload genuine and lawfully held rejection letters, hospital bills, discharge summaries and clinical notes;
• not engage a competing service to pursue the same claim without notifying ClaimIQ;
• notify ClaimIQ promptly of any direct communication received from the scheme, administrator or hospital in relation to the disputed claim.

The Client consents to the processing of their personal information, including special personal information (health data), as described in thePOPIA Notice. This includes disclosure to the scheme, the CMS (if escalated) and ClaimIQ’s internal clinical / dispute reviewers, and processing through an automated AI clinical audit pipeline with human review before submission.

The mandate remains in force until (i) the matter is finalised (recovery, write-off, or a final scheme / CMS ruling that cannot reasonably be taken further), (ii) the Client revokes it in writing, or (iii) ClaimIQ terminates it under the circumstances set out in the Terms of Service (for example, material inaccuracy or non-cooperation).

This Service Agreement is governed by the laws of the Republic of South Africa, including the Medical Schemes Act 131 of 1998, the Consumer Protection Act 68 of 2008 and the Protection of Personal Information Act 4 of 2013.

The Client accepts this Service Agreement by completing the intake, paying the applicable tier Case Review fee (R500, R1,500 or R3,000 depending on the disputed claim amount) and confirming the on-screen consent that authorises ClaimIQ to act on their behalf.

ClaimIQ SA (Pty) Ltd
Registration No.: [Pending CIPC Registration]
Email: support@claimiq.co.za