Refund Policy

ClaimIQ offers a transparent tiered flat-fee model. We do not provide financial, investment or medical scheme advice and are not required to be registered as a Financial Services Provider. We provide an administrative and clinical claim review and dispute service only.

The Case Review Fee is a single, flat rand amount set by the size of the claim you are disputing (i.e. the disputed / rejected amount you enter at intake). It is not a percentage,not a commission andnot tied to the amount recovered.

No success fee, no commission, no percentage:the applicable tier fee above is the only fee we charge in respect of a given claim. We take no cut of any amount your medical aid releases — every rand recovered goes directly to you or your provider.

The Case Review Fee is a fee for a professional service that begins as soon as payment is received. By paying the fee you expressly request that we commence the review immediately and you acknowledge, in line with section 44(3) of the ECTA, that your right to cool-off does not apply to services that have already started with your consent.

Because the work (clinical assessment, scheme rule analysis, document review and engagement strategy) is performed up-front, the tier fee you paid is not refundable once we have begun working on the matter, including in cases where:

• the claim cannot reasonably be overturned;
• you decide not to proceed after the review is delivered;
• your medical aid has already finalised the matter beyond appeal;
• the information or documents you provided are incomplete or inaccurate.

In the spirit of the Consumer Protection Act, we will refund the Case Review Fee you paid (whichever tier applies to your claim) in the following limited circumstances:

• Duplicate payment: you were charged the same tier fee twice for the same matter.
• Wrong tier charged: the tier applied was higher than the correct tier for the claim amount you entered — in which case we refund the difference.
• We have not started: you cancel in writing before we have started the review and before any work product has been created on your file.
• We decline the matter: we determine, before starting substantive work, that we are unable to assist (for example, the matter falls outside our scope).
• Material failure on our side: we fail to deliver the agreed review within a reasonable period and have not communicated a valid reason for the delay.

ClaimIQ SA operates a strict tiered flat-fee model. The applicable tier fee (R500, R1,500 or R3,000, based on the disputed claim amount) is the complete fee for our service in respect of that claim. We do not charge, invoice or accept:

• any percentage of the amount recovered from your medical aid;
• any commission, success fee, contingency fee or bonus tied to outcome;
• any deduction from funds released by the scheme to you or your provider.

Every rand your medical aid releases is paid directly to you or to your hospital / provider. Nothing flows through us.

To request a refund, please contact us within 30 (thirty) days of the charge:

• Email: refunds@claimiq.co.za
• Include: your full name, ID number, the case reference (e.g.CS-XXXX), the date of payment, proof of payment, and a short reason for the request.

We will acknowledge your request within 3 (three) business days and provide a final written response within 14 (fourteen) business days. Approved refunds are paid back to the original payment method within 10 (ten) business days of approval.

Please contact us first before lodging a chargeback with your bank or card provider. Many disputes are caused by miscommunication and can be resolved quickly. Fraudulent or unjustified chargebacks may be defended with evidence of the services rendered.

Nothing in this policy limits any right you have under the Consumer Protection Act 68 of 2008, the Electronic Communications and Transactions Act 25 of 2002, or any other applicable South African law. Where any provision of this policy conflicts with a right that cannot be excluded by agreement, that right prevails to the extent of the conflict.

If you are not satisfied with our final response, you may refer the matter to:

• The National Consumer Commission (NCC) — www.thencc.gov.za
• The Consumer Goods and Services Ombud (CGSO) — www.cgso.org.za
• For complaints about the underlying medical scheme decision: the Council for Medical Schemes (CMS) — www.medicalschemes.co.za

ClaimIQ SA reviews and disputes rejected medical aid claims on your behalf. We do not sell medical aid or gap-cover products, we do not provide financial advice as contemplated in the Financial Advisory and Intermediary Services Act 37 of 2002 (“FAIS”), and we are therefore not licensed as a Financial Services Provider. Our work is administrative, clinical and dispute-resolution based.

We may update this Refund Policy from time to time. The latest version will always be available on this page with an updated effective date. Material changes will be communicated to active clients by email.

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