3 - Insurance policies Flashcards
What are three main points important about the policy document?
- the policy will contain the details of the T&Cs
- the parol evidence rule applies ( the parties can only rely on the contract itself, not on negotiations leading to the contract)
- the policy is only EVIDENCE of the contract and not the contract itself
What form is a policy generally issued in?
A schedule form.
The policy wording is pre-printed (often in a booklet) and a schedule is incorporated into the policy. Also, containing all the variable information and details of the specific risk
What does contra proferentem mean?
The contra proferentem rule is a legal doctrine in contract law which states that any clause considered to be ambiguous should be interpreted against the interests of the party that created, introduced, or requested that a clause be included.
What is a basic structure of all general insurance policies?
- Heading
- Preamble
- Signature clause
- Operative clause
- Exclusions
- Conditions
- Policy schedule
- Information and facilities
What will the heading section of a policy contain?
The name of the insurer and, in some cases, the address and company logo.
What is the purpose of the recital clause/preamble?
“Sets the scene” - refers to the two parties coming together to form the contract and outlines the purpose of the contract (the insurer promising to indemnify the insured in return for a premium).
What is the operative clause (insuring clause) section of a policy?
The heart of the policy, outlining what is covered. There may be several clauses, each dealing with a different aspect of the insurance and often containing exclusions that are specific to the clause concerned.
What is a condition?
A contractual term that the insured agrees to comply with during the cover period.
What two types of conditions are there?
Express: A condition witch is stated in the policy
Implied: A condition implied by common law that is not expressly stated in the policy
What would be contained within the policy schedule?
The schedule contains the variable details of the policy such as the:
- insured’s name and address;
- policy period;
- policy number;
- premium;
- details of the subject matter;
- sum insured or limit of liability;
- special exclusions, conditions or aspects of cover; and
- operative sections of the policy.
What may include information and facilities section of the policy?
- definitions,
- a customer service standards statement,
- the complaints procedure and
- claims information.
In which policy section would you find the statement ‘This policy is evidence of the contract between us based on the information you gave us in the proposal form.’?
Preamble
In which policy section would you find the statement ‘Any claim for theft is dependent on the loss being reported to the police within seven days.’?
Conditions
What are the two types of exclusions found in most general insurance policies?
- General exclusions - apply to all sections of the policy
- Specific exclusions - apply to specific parts of a policy
What is mean by market exclusion?
Some general exclusions are common to all insurance policies
What are some common market exclusions?
- War and related perils
- Radioactive contamination and explosive nuclear assemblies
- Terrorism (for commercial insurance, esp property)
- Pollution/contamination (for property insurance)
- Cyber risk (except for specialist insurance)
- Sonic bangs
- Contractual liability (liability which only exists due to a contract the insured has entered into)
- Marine (property covered by a marine policy is excluded from a property policy)
When terrorism cover can be purchased?
Insurer’s can offer terrorism cover but it must be purchased on an “all-risks” basis, cover all the policy and all property locations. The insurer then reinsures it through a mutual re-insurer, Pool Re, which was setup in collaboration with the UK government and backed by a treasure guarantee. The insurer’s liability is capped per event and year and in Northern Ireland is provided directly by the government.
What are the main express conditions?
- Duties of the insured
- Alteration
- Action by the insured in event of a claim
- Fraud
- Reasonable precautions
- Contribution
- Subrogation
- Average
- Arbitration
- Cancellation
What is a reasonable precaution condition?
The insured must take all reasonable precautions to minimise the risk of loss or damage or of incurring liability. They should act in the same way as they would if uninsured.
What is the purpose of a subrogation condition?
At common law, the insurer has the right to take over the insured’s rights, following a loss and payment of a claim, to recover the loss from the party responsible.
The policy condition allows the insurer to start to pursue recovery rights before payment of the loss (although the actual recovery of money must take place afterwards).
What is the purpose of an average condition?
If the policyholder has ‘under-insured’ - i.e. declared a value for the risk that is less than the full value - thus paying less than the appropriate premium - the insurer reserves the right to pay only a proportion of any claim, in line with the amount of under-insurance.
What is an arbitration condition?
This states that any disputes regarding quantum, meaning the amount to be paid in settlement of a claim, will be judged by an independent arbitrator.
Jo’s insurer reduces the amount of her theft claim as her shop contents are not insured for their full value.
What is this an example of?
Average
The reduction of Jo’s theft claim due to her being underinsured.
Ken’s motor insurer writes to the driver that drove into the back of Ken, for reimbursement of their outlay to repair Ken’s car. What is this an example of?
Subrogation
Subrogation is the condition that allows an insurer to reclaim costs from a third party, such as the one who caused the damage to Ken’s car.
