Our Terms and Conditions

CLAIMIFY TERMS & CONDITIONS OF SERVICE

Last updated: 10 September 2025

Important: These Terms & Conditions ("Agreement") govern the provision by Claimify (Pty) Ltd (referred to in these Terms as “Claimify”, “we”, “us” or “our”) of claim-assistance services to the person or entity that instructs Claimify and pays the processing fee (the “Client” or “you”). By instructing Claimify and/or paying the Processing Fee you accept and agree to be bound by these Terms. If you do not agree, do not instruct Claimify or pay the Processing Fee.

1. DEFINITIONS AND INTERPRETATION

1.1 In this Agreement, unless the context otherwise requires:

• Agreement means these Terms & Conditions and any schedules, annexures or write-ups which Claimify provides to the Client from time to time.

• Services means the assistance, administration, negotiation, representation (as agent) and related actions Claimify provides to attempt to obtain approval and/or payment from a Medical Aid, Gap policy or other payer in respect of a healthcare claim (including authorisations, appeals, correspondence, record requests, submissions and negotiations with third parties), but expressly excluding legal representation in Court unless otherwise agreed in writing.

• Processing Fee means the once-off, non-refundable fee charged by Claimify for assessment and commencement of Services: R999.99 (South African Rand nine hundred and ninety-nine and ninety-nine cents), payable on submission/registration/acceptance as set out below.

• Success Fee means 25% (twenty-five percent) of the Claim Amount, payable in addition to the Processing Fee where there is an approval or recovery as set out in clause 4.

• Claim means the specific claim or claims that Claimify has been instructed to pursue on the Client’s behalf from a Medical Aid, Gap insurer or other payer — including any application for authorisation, appeal, reimbursement, short-fall recovery or similar request submitted or pursued by Claimify (whether submitted directly by Claimify or by a Provider or other third party as a result of Claimify’s efforts).

• Claim Amount means the gross monetary amount that is received, approved, authorised or credited as a direct or indirect result of Claimify’s Services in respect of the Claim (including authorisations, payments, reimbursements, credits to the Client or to any Provider, and partial approvals). Claim Amount is calculated before deduction of the Processing Fee, Success Fee, bank charges, withholding taxes or other statutory deductions.

• Active Efforts means the period during which Claimify is actively performing substantive actions to progress the Claim after receipt of the Processing Fee and Client consents — including but not limited to preparing and submitting documentation, making formal submissions or appeals, liaising with Providers or Medical Aids, obtaining medical records, and negotiating with payers. Active Efforts exclude passive monitoring or archival storage of client files.

• Medical Aid means any medical scheme, medical insurer or medical aid scheme registered or operating in South Africa (or any other jurisdiction) which is the target payer for the Services.

• Gap Policy means any short-term policy, top-up or gap cover policy that provides supplementary payments in respect of shortfalls or co-payments.

• Provider means any healthcare provider (doctor, hospital, pharmacy, clinic, laboratory, allied health professional) involved in the Claim.

• Arbitration means the process of referral of a dispute to an independent neutral arbitrator (or panel) for final and binding determination outside of the ordinary court process, as further defined in clause 15.

• Arbitrator means the person appointed to decide the matter in Arbitration (in terms of clause 15, the primary nominated arbitrator is Michal Karp of Cranco Karp Attorneys, or any alternate appointed pursuant to clause 15).

• Headings are for convenience and shall not affect interpretation.

1.2 Interpretation rules: singular includes plural and vice versa; references to statutes include amendments; references to “including” mean “including without limitation”.

2. SCOPE OF SERVICES

2.1 Claimify will, on the Client’s instruction and subject to receipt of the Processing Fee and the consents required under clause 9, use reasonable skill and care to:

• assess the eligibility of the Client’s Claim(s);

• prepare, lodge and follow up the Claim(s) with the relevant Medical Aid, Gap insurer or other payer;

• obtain clinical records and other documents necessary to pursue the Claim (subject to the Client’s consents);

• liaise with Providers, Medical Aids and insurers as required to pursue approvals or payments;

• negotiate settlements or obtain authorisations where reasonably appropriate; and

• perform related administrative tasks as agreed.

2.2 The Services do not include legal representation in Court, provision of legal advice, or the payment of any fees, taxes or sums due to Providers or third parties on behalf of the Client unless explicitly agreed in writing. If litigation or formal legal representation is required, separate engagement terms, retainer and fees will apply.

3. AUTHORITY, CONSENTS & CLIENT OBLIGATIONS

3.1 By instructing Claimify and paying the Processing Fee the Client:

a) authorises Claimify (and its employees, agents and subcontractors) to act as the Client’s authorised agent for the purpose of pursuing the Claim, including to liaise with Medical Aids, Providers, insurers and third parties, to request, receive and transmit medical records and other information and to accept or negotiate authorisations or payments on the Client’s behalf to the extent reasonably necessary for the provision of the Services; and

b) expressly consents to Claimify processing, storing and sharing the Client’s personal and medical information in accordance with clause 9.

3.2 The Client warrants and undertakes that:

a) all information and documentation provided to Claimify is complete, true, accurate and not misleading;
b) the Client has the authority to provide personal and medical information and to appoint Claimify as agent;
c) the Client will promptly provide all documents, instructions, consents, powers of attorney or other assistance that Claimify reasonably requests to enable performance of the Services; and
d) the Client will not instruct Claimify to act where the Client knows or suspects the Claim or information to be fraudulent.

3.3 Claimify may, at its discretion, decline to act, suspend Services or terminate this Agreement where the Client fails to provide requested information, where fraud is suspected, or where continuing to act would expose Claimify to legal/regulatory risk.

4. FEES, TAX & PAYMENT

4.1 Processing Fee: The Client shall pay the Processing Fee of R999.99 (inclusive of any applicable VAT where Claimify is required to charge VAT) immediately upon registration/engagement. The Processing Fee is non-refundable except where otherwise required by mandatory law.

4.2 Success Fee: If, as a direct or indirect result of Claimify’s Services, any Claim Amount is received, approved or authorised, the Client shall pay Claimify a Success Fee of 25% (twenty-five percent) of the Claim Amount (exclusive of the Processing Fee). The Processing Fee is a separate, non-refundable charge and does not reduce, offset or form part of the Success Fee.

4.3 When Success Fee is due: The Success Fee becomes due and payable immediately upon the date the Claim Amount is granted, authorised or paid (the Due Date). Claimify will issue an invoice for the Success Fee on or immediately after the Due Date. The Client shall settle the invoice immediately and in any event no later than 30 (thirty) days from invoice date.

4.4 12-MONTH TIME PERIOD / SURVIVAL: Notwithstanding termination of this Agreement for any reason, if any Claim Amount (in whole or in part) is received, approved or authorised within 12 (twelve) months from the date Claimify last performed Active Efforts in respect of the Claim, the Client shall pay the Success Fee in respect of such Claim Amount. For clarity, the 12-month period runs from the date of the last substantive action performed by Claimify (the Active Efforts End Date); any Claim Amount received within 12 months of that date is subject to the Success Fee as if the Agreement were still in force.

4.5 VAT and other taxes: All fees are exclusive of VAT and any other taxes, duties, levies or imposts which will be added to Claimify’s invoices where applicable and payable by the Client.

4.6 Payment methods: Payment shall be made by EFT/bank transfer, card, debit order, or any method specified by Claimify. Bank charges, currency conversion costs and any third-party payment fees are for the Client’s account.

4.7 Late payment & collections: If the Client fails to pay any amount by the due date:

a) Claimify may charge interest on overdue amounts at the rate of prime rate plus 2% per annum (or such other rate permitted by law) calculated from the due date to the date of actual payment, compounded monthly in arrear;
b) Claimify may suspend Services, restrict access to its systems, and/or refer the matter to debt collection or attorneys for recovery;
c) the Client will be liable for all collection costs, tracing fees, administration fees and legal costs incurred by Claimify in recovering amounts owing (including legal costs on the attorney-and-client scale and collection agency commissions) to the extent permitted by law; and
d) Claimify shall be entitled to enforce any security or right of set-off against monies due to the Client to recover the Success Fee.

4.8 Calculation on partial approvals/payments: Where only part of a Claim is approved/paid, the Success Fee shall apply pro rata to the portion actually approved or paid. If a Claim Amount is subsequently reversed, adjusted or recovered from the Client by a Medical Aid or insurer, the Client must promptly repay any Success Fee relating to the reversed amount and Claimify may recover the overpaid Success Fee plus interest and collection costs.

4.9 No set-off by Client: The Client shall not be entitled to withhold, set-off or deduct any amount from any monies due to Claimify unless expressly agreed in writing by Claimify.

5. REFUNDS, CANCELLATION & TERMINATION

5.1 Processing Fee non-refundable: Except as required by mandatory consumer protection law, the Processing Fee is non-refundable once paid. If Claimify declines to provide Services prior to any substantive work, Claimify may, in its discretion, refund a portion of the Processing Fee less administration costs; however Claimify has no obligation to do so.

5.2 Claimify discretion to act: Claimify may, in its sole and absolute discretion, decide whether or not to proceed with any Client request, instruction or Claim. Claimify is under no obligation or expectation to act on any matter. If Claimify decides not to act, the Processing Fee remains non-refundable.

5.3 Termination by Claimify: Claimify may terminate this Agreement immediately on written notice if the Client commits a material breach (including providing false information), if fraud is suspected, or where continuing to act would expose Claimify to legal/regulatory risk. Termination does not affect Claimify’s right to be paid any fees due for work performed prior to termination, nor does it affect Claimify’s entitlement to any Success Fee in respect of Claim Amounts received within the 12-month period described in clause 4.4.

5.4 Client termination: The Client may terminate instructions by written notice to Claimify, but this will not affect Claimify’s entitlement to the Processing Fee or any Success Fee which becomes due following receipt of Claim Amounts that are the result of Claimify’s work prior to termination (including Claim Amounts received within the 12-month period).

6. NOT A LAW FIRM / NO COURT REPRESENTATION

6.1 Not legal advisers: Claimify is not a law firm, is not a legal practitioner organisation, and does not provide legal representation or advocacy in Courts. Claimify will not appear as counsel or attorney for the Client in any Court or tribunal unless a separate written legal retainer is executed with a duly qualified legal practitioner.

6.2 No legal advice: While Claimify may liaise with attorneys or advise on administrative processes, Claimify’s Services do not constitute legal advice. If legal advice or Court representation is required, the Client should seek independent legal counsel.

7. NO GUARANTEES, NO EXPECTATION & LIMITATION OF LIABILITY

7.1 No guarantees or promises: The Client acknowledges that Claimify makes no guarantees, warranties or promises regarding the success of any Claim, the timing of approvals/payments, or any clinical or medical outcomes. All examples, predictions and estimates are illustrative only.

7.2 No expectation: The Client expressly accepts that there is no guarantee or expectation that Claimify will act, complete any particular task, achieve any outcome, or obtain any particular payment. Claimify may at any time, in its sole discretion, decline or stop acting.

7.3 Limitation and cap on liability: To the fullest extent permitted by law:

a) Claimify will not be liable for any indirect, consequential, special, punitive or incidental loss or damage (including loss of profits, loss of income, emotional distress or loss of opportunity) arising out of or in connection with the Services; and
b) Claimify’s total aggregate liability to the Client for any claim, loss or damages (whether in contract, delict/tort or otherwise) shall be limited to the lesser of: (i) the Success Fee actually paid by the Client for the relevant Claim; or (ii) R50,000 (fifty thousand Rand).

7.4 Exceptions: Nothing in this Agreement shall exclude or limit liability for death or personal injury resulting from Claimify’s gross negligence, or any liability which cannot be excluded by law.

8. INDEMNITY

8.1 The Client indemnifies and holds harmless Claimify, its officers, employees, agents and subcontractors against any claim, loss, damages, costs or expenses (including legal costs on an attorney-and-client scale) arising from:

a) any inaccurate, false or misleading information provided by the Client;
b) any breach of the Client’s warranties or obligations under this Agreement;
c) any unauthorised act or omission by the Client; and
d) any claim by a third party arising from the Client’s instructions to Claimify, except to the extent such claim arises from Claimify’s gross negligence or wilful misconduct.

9. DATA PROTECTION, POPIA & CLIENT CONSENT

9.1 Consent to process and share: The Client hereby expressly grants Claimify permission to collect, store, process, use and share all information provided to Claimify (including personal information, contact details and special personal information such as medical records and health information) with Providers, Medical Aids, Gap insurers, attorneys, service providers and other third parties insofar as reasonably necessary to provide the Services and to pursue the Claim. The Client’s consent is given to the extent permitted by applicable data protection laws, including the Protection of Personal Information Act, 2013 ("POPIA").

9.2 Use as Claimify deems fit: Subject to applicable law, the Client expressly authorises Claimify to use, retain, analyse and share the Client’s information (including anonymised summaries and statistics) as Claimify reasonably considers necessary for the provision of Services, administration, quality assurance, internal analytics and Claimify’s business purposes. The Client accepts that withdrawing consent may impede Claimify’s ability to act and will not relieve the Client of payment obligations that have already arisen.

9.3 Security and transfer: Claimify will take commercially reasonable technical and organisational measures to protect personal information. The Client accepts that Claimify may store or transfer information outside South Africa where necessary to deliver the Services, subject to Claimify’s obligations under applicable law.

9.4 Data subject rights: The Client may exercise their rights under applicable data protection law (including access, correction and objection rights) by contacting Claimify at the contact details in clause 21. Claimify will respond to requests in accordance with applicable law. If the Client withdraws consent to processing, Claimify may suspend or stop Services and will not be obliged to refund the Processing Fee.

10. CONFIDENTIALITY & PUBLICITY

10.1 Confidentiality: Each party shall keep confidential and not disclose to any third party any confidential or proprietary information obtained from the other party in the performance of the Services, except where disclosure is:

a) required for the provision of Services (including disclosure to Medical Aids, Providers, labs and insurers);
b) required by law, regulation, court order or governmental body; or
c) with the prior written consent of the disclosing party.

10.2 Publicity and marketing: Claimify may (unless the Client instructs otherwise in writing) include anonymised case studies and statistics relating to successful recoveries in its marketing materials. Claimify will not publish identifiable medical records or personal health information without the Client’s prior written consent (except where required by law).

11. INTELLECTUAL PROPERTY

11.1 All intellectual property rights in materials, templates, processes, methodologies and software used or developed by Claimify in connection with the Services remain the exclusive property of Claimify. The Client is granted a non-exclusive, non-transferable licence to use any deliverables solely for their own internal purposes.

12. SUBCONTRACTING, ASSIGNMENT & THIRD PARTIES

12.1 Subcontracting: Claimify may subcontract or appoint agents to perform any of its obligations under this Agreement. Claimify remains responsible for the acts and omissions of such subcontractors to the extent required by law.

12.2 Assignment: Claimify may assign, cede or transfer any of its rights or obligations under this Agreement (including the Success Fee). The Client may not assign this Agreement without Claimify’s written consent.

13. FORCE MAJEURE

13.1 Claimify shall not be liable for any failure or delay in performing its obligations where such failure or delay is caused by events beyond its reasonable control (including strikes, pandemics, acts of governmental authority, IT failures, power outages, or other force majeure events). Claimify shall promptly notify the Client of such an event and take reasonable steps to mitigate its effects.

14. SEVERABILITY, WAIVER & SURVIVAL

14.1 If any provision of this Agreement is held to be invalid, illegal or unenforceable, that provision shall be severed to the minimum extent necessary and the remaining provisions shall continue in full force and effect.

14.2 No failure or delay by a party to exercise any right under this Agreement shall operate as a waiver of that right.

14.3 All clauses that by their nature should survive termination (including clauses 4.4, 4.8, 5.1, 6, 7, 8, 9, 11, 14 and 16) shall survive termination or expiration of this Agreement.

15. DISPUTE RESOLUTION — BINDING ARBITRATION

15.1 Agreement to arbitrate: The parties agree that any dispute, controversy or claim arising out of or relating to this Agreement (including its formation, interpretation, performance, breach, termination or validity) shall be finally resolved by binding arbitration administered as set out in this clause. The parties confirm that they will not commence litigation in any Court in respect of any dispute before first referring the matter to arbitration, except for urgent interlocutory relief as permitted below.

15.2 Arbitrator / Appointment: The parties agree that arbitration shall be conducted by Cranco Karp Attorneys with Michal Karp (or, if Michal Karp is unwilling or unable to act, another attorney nominated by Cranco Karp Attorneys) acting as sole Arbitrator. If Michal Karp is unavailable, Cranco Karp Attorneys shall nominate an alternate arbitrator who is a qualified attorney with at least five years’ post-admission experience. The parties accept and agree to this specific arbitrator appointment in advance.

15.3 Seat and governing law: The seat of Arbitration shall be Johannesburg, South Africa. The arbitration shall be governed by the laws of the Republic of South Africa and, to the extent applicable, the Arbitration Act, 1965 (and any statutory replacement or amendment) and principles of South African law.

15.4 Timelines / expedition: The parties agree and direct the Arbitrator to conduct the Arbitration on an expedited basis with the following timetable (subject only to reasonable circumstances and the Arbitrator’s direction):

a) The Arbitrator shall be appointed (or confirmation of Michal Karp’s availability obtained) within 7 (seven) days of referral to Arbitration.
b) The Arbitration hearing (if any) and final award shall be completed and delivered within 30 (thirty) calendar days from appointment of the Arbitrator, unless the Arbitrator determines, in writing, that additional time is reasonably necessary. The Arbitrator shall conduct the procedure in such manner as to meet these timelines while ensuring fairness.

15.5 Procedure and evidence: The Arbitrator may determine the procedure (documents only, remote hearing or oral hearing) and shall admit such evidence as the Arbitrator considers relevant and admissible. The Arbitrator has the power to make rulings on interim relief, costs and confidentiality.

15.6 Finality and enforcement: The Arbitrator’s award shall be final and binding on the parties. Judgment upon the award may be entered in any competent court having jurisdiction.

15.7 Costs: The costs of the Arbitration (including the Arbitrator’s fees) shall be determined by the Arbitrator in the award. Absent an award otherwise, each party shall bear its own legal costs and an equal share of the Arbitrator’s fees, provided that the Arbitrator may award costs (including attorneys’ costs on an attorney-and-client scale) to the prevailing party where the Arbitrator deems it appropriate.

15.8 Urgent relief: Nothing in this clause prevents a party from approaching a court for urgent interim relief where such relief is necessary to preserve that party’s rights pending the arbitration; however, any such application shall not be a waiver of the obligation to arbitrate the merits of the dispute.

16. JUSTIFICATION CLAUSE

16.1 Provision of reasons: Where Claimify takes a material adverse decision with respect to a Client (including but not limited to declining to act on a Claim, terminating this Agreement, refusing a particular request or closing a file), the Client may within 14 (fourteen) days of such decision request, in writing, a brief written justification from Claimify setting out the factual and/or legal reasons for the decision (a Justification Request). Claimify will provide a written response within 14 (fourteen) days of receipt of a valid Justification Request unless a shorter period is legally required.

16.2 Limited content of justification: The written justification shall be concise and shall not be required to disclose privileged communications, detailed legal strategies, proprietary methodologies, internal scoring algorithms, or confidential commercial information. The justification is intended to provide transparency and reasoned explanation only.

16.3 No alteration of rights: The provision of a justification does not alter the substantive rights of either party under this Agreement and is without prejudice to Claimify’s rights to rely on any legal limitation, defence or to charge fees as provided herein.

17. ENTIRE AGREEMENT & VARIATION

17.1 This Agreement constitutes the entire agreement between the parties regarding its subject matter and supersedes all prior communications and agreements (whether oral or written).

17.2 No variation of this Agreement shall be effective unless in writing and signed by both parties (except that Claimify may update these Terms by publishing a revised version on its website; continued use of Services following publication shall constitute acceptance of such revised Terms).

18. ELECTRONIC & COUNTERPART SIGNATURES

18.1 This Agreement may be executed and accepted electronically (including by electronic payment of the Processing Fee, clicking an acceptance button, or by email). Electronic signatures shall be valid and binding to the same extent as handwritten signatures.

19. CONSUMER PROTECTION & STATUTORY RIGHTS

19.1 To the extent the Client is a consumer or has statutory protection (including under the Consumer Protection Act, 2008), these statutory rights are unaffected to the extent they cannot be lawfully excluded or limited. Nothing in this Agreement is intended to exclude or limit rights that the Client may have under mandatory law.

20. CONTACT & COMPLAINTS

20.1 For service queries, notices, data requests or complaints, contact Claimify at:

• Email: claims@claimify.co.za

20.2 Claimify will acknowledge complaints promptly and will attempt to resolve complaints within a reasonable time.

21. MISCELLANEOUS

21.1 No partnership or employment: Nothing in this Agreement creates a partnership, joint venture or employment relationship between Claimify and the Client. Claimify acts solely as an independent contractor and, where appropriate, as the Client’s authorised agent for limited purposes.

22. SIGNATURE / ACCEPTANCE

By paying the Processing Fee, clicking to accept these Terms, or by otherwise instructing Claimify, the Client confirms that the Client has read, understands and accepts these Terms & Conditions and authorises Claimify to proceed.