10. Claims Handling

Question 1

Loss adjuster

Answer 1

Agent of insurer to inspect damages and recommend repairs

Question 2

Brokers role

Answer 2

First point of contact of claim, communicates with insurer

Question 3

IUA Company Market (non-marine)

Answer 3

Broker must obtain agreement of all insurers

Question 4

IUA Company Market (marine)

Answer 4

Advice can be agreed by lead company market UW

Question 5

IUA Company Market (marine) (not excess of loss)

Answer 5

If Lloyd’s involvement, only one company can bind the rest of the Company Market

If not Lloyd’s, two companies are required to agree

Question 6

IUA Company Market (aviation) (not excess of loss)

Answer 6

If direct business, 2 companies must agree.

Facultative reinsurance, first company only

Question 7

Non marine company code format

Answer 7

A1234

Question 8

What is a complex claim?

Answer 8

Has two leaders

Question 9

When will a non-financial claim be complex?

Answer 9

There is a claim for extra contractual damages
There is an allegation of insurers not compliance with regulation
There are active or potential dispute resolution proceedings

Question 10

What is the electronic claims file (ECF)?

Answer 10

Platform to load and submit data and documents to insurers not located in London

• data messaging system / database
• Document repository

Question 11

Loss assessor

Answer 11

Agent of the insured to prepare a claim

Question 12

What is a FOS directions award?

Answer 12

FOS redress by telling the firm what actions to take to make right

Question 13

Marine / aviation company code format

Answer 13

3000/01

Question 14

Document governing Lloyd’s claims handling

Answer 14

Lloyd’s Claims Lead Arrangements

Question 15

DXC / XCS in claims process

Answer 15

Entering data, sending out messages, moving funds - technical processing

Question 16

Organisational conflict

Answer 16

Insurer as a whole decides it cannot be an agreement party

Question 17

Claims handling process

Answer 17

Broker is notified and notifies appropriates insurer(s)
Broker submits info
Agreement parties consider info
XCS enters the claims data
Broker receives insurer comments and daily updates
Agreement and debit of funds to broekr
Broker updates the file

Question 18

FOS Money Award limits

Answer 18

£430k if data act was on or after 1 April 2019

£195k if before 1 April 2019

Question 19

Individual conflict

Answer 19

Internal conflict

Question 20

Non-marine underinsurance

Answer 20

Known as average

In marine, average means loss

Question 21

When will a financial claim be a complex claim?

Answer 21

• The amount claimed ,
  Net of any deductibles ,
  to the Lloyd’s share on a single risk is

More than £1m for third party
More than £2m for first party
More than £5m for excess of loss RI

Question 22

Marketing

Answer 22

Highlight issues to arise out of marketing
Claims as a publicity tool

Question 23

Management Information

Answer 23

MI should liaise with claims for input
MI should review reports with claims

Question 24

Claims & UW

Answer 24

Report wordings that cause confusion
Advise clarity of wordings
Provide claims data
Liaise concerning intent if a claim is outside of coverage

Question 25

Legal

Answer 25

Liaise outsourcing of claims
Liaise claims in litigation
Legal to advise on wordings

Question 26

Senior management / board

Answer 26

Report large claims
Report matters of wider importance

Question 27

Finance

Answer 27

Early warning of large claims
Liaise in cases of high volume

Question 28

Claims & outwatds RI

Answer 28

Provide data
Code losses accurately
Keep data up to date

Question 29

Complaints

Answer 29

Provide clear info about claims handling
Complaints should provide advice on regulatory info to claims