2 Determining Existence of Cover

Question 1

Claim handling process first step

Answer 1

Is claim covered?

Question 2

Claim handling process

Answer 2

1. Claim covered
2. TP claims - is insured liable
3. Value
4. Settlement
5. Recoveries

Question 3

Schedule contains…

Answer 3

Policy number
Name
Address
Cover
Period
Excess
Limits
Premium
Endorsements

Question 4

Which is the most important part of insurance contract?

Answer 4

Insuring clause (promise to pay in return for premium payment). In commercial policies there may be more than one insuring clause.

Question 5

Definition section describes…

Answer 5

key terms

Question 6

Limit of indemnity

Answer 6

i.e one loss or aggregate

Question 7

Deductibles or excess is paid by

Answer 7

insured

Question 8

extensions widen…

Answer 8

cover

Question 9

exclusions narrow..

Answer 9

cover

Question 10

Common exclusions..

Answer 10

Fraud
Not fortiutous
Deliberate acts
Other insurance
Criminal fines
Circumstances already known
War, nuclear risk etc

Question 11

Interpreation section

Answer 11

rules of construction

Question 12

Law

Answer 12

Usually England & Wales

Question 13

Complaints

Answer 13

policy contains details of complaint process

Question 14

Market Reform Contract

Answer 14

Share of risk underwriter accepts.

Question 15

Claims Made

Answer 15

Claims only accepted during period of insurance

Question 16

Claims occurring

Answer 16

Claims may take years to come through

Question 17

Notification conditions

Answer 17

Sometimes a condition precedent

Question 18

Prompt notification of claim required for:

Answer 18

Allow recovery
Minimise loss
Meet court deadlines
Defend claim

Question 19

Kajima v Lloyds

Answer 19

Only items notified (not other issues related)

Question 20

HLB Kidson v Lloyds

Answer 20

No doubt communication was notification.

Question 21

Aspen v Pectel

Answer 21

Real risk claim would be made (Confirmed in Laker Vent v Templeton)