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Insurance > 4.2 Claims: Handling > Flashcards

4.2 Claims: Handling Flashcards

1
Q

When will insurer be litigating against 3rd, usually

A

Subrogated claim in name of insured or for broker’s BoD

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2
Q

Third figure in reserve table

A

Costs (Defendant)

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3
Q

What should go in status of claim

A

Current status of Ps, e.g. LoC received, proceedings commenced, notification received

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4
Q

When will insurer be litigating against insured, usually

A

Over policy wording, refusing to pay out, or trying to avoid

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5
Q

When will a Client Care Letter be required

A

If S is not on the panel for the insurer - one-off instruction

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6
Q

What are the defence costs covering in the reserve

A

For both insured and the other side - stage to show costs if settles early

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7
Q

After considering notification clause, consider what two things

A

Any avoidance issues and relevant exclusion clauses

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8
Q

What is an IBNR reserve

A

Claims incurred but not yet reported, e.g. extreme weather event

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9
Q

Two situations in which litigation can ensue

A

Against 3rd or against insured

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10
Q

If there is a breach of a general condition, remedy would be what

A

Damages, but negligible

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11
Q

What two columns of figures should there be in reserve table

A

To trial and to early settlement

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12
Q

What is a market report

A

Coverage report addressed to entire market

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13
Q

Always remember to take what off quantum table

A

Excess to be paid by insured

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14
Q

What does an SLA set out

A

Standard of service, how it will be measured, fees, DR and termination

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15
Q

Before responding to insured, what should S always do on behalf of insurer

A

Reserve rights

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16
Q

Why does S usually attend market meetings

A

To advise + keep discussions privileged

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17
Q

After avoidance issues + exclusion, what next in Coverage

A

Insurers should (not) provide cover bc

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18
Q

What 6 things to include at top of initial report

A

Insured, Claimant, Date of Claim, Date of Accident/event, Insurer’s reference, Recipient and address

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19
Q

Two different options to include in Strategy part of report

A

Consequences if insurers decide to accept, and consequences if decide to deny, w/ recommendations

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20
Q

Why does insurer deal w/ claims instead of insured

A

Control costs and look from commercial perspective

21
Q

After going through insuring clause + if within policy period, what next in Coverage

A

Go through Limit of indemnity, defence costs, and excess

22
Q

What is the indemnity part of reserve covering

A

Exposure of insurer under the policy - losses recoverable under policy

23
Q

Panel Ss usually have what C w/ insurers

A

Service Level Agreement

24
Q

What are the two main ways of reporting to the market

A

Market meetings and market reports

25
Q

If insurer is successful in subrogated claim, what happens with recovering from reinsurer

A

Will take account of subrogated recovery

26
Q

First figure in reserve table

A

Liability

27
Q

Three different kinds of reserves

A

Open claims, IBNR and IBNER

28
Q

Timeline of claims handling

A

Notification by insured to broker/insurer; insurers contacts Ss; Ss acknowledge instructions; Ss build initial report

29
Q

What is the potential consequence of failing to keep insurer updated

A

Negligence

30
Q

What to contain in ‘Liability’ part

A

Discussion of claim against insured - potential defence? Concede liability?

31
Q

Why does insurer need to be updated of improvement/deterioration

A

Advance notice needed of any pay out, needs to be able to input, and for financial year reporting Os

32
Q

Fifth figure in reserve table

A

Subtract excess/deductible

33
Q

What should you consider to see if S needs to advise on reserve

A

SLA

34
Q

What are market meetings

A

Claims handlers from each insurer discuss claim

35
Q

6 parts to initial report

A

Facts of claim, status, coverage, liability, quantum, strategy & recommendations

36
Q

Why should S collect witness statements ASAP

A

Before ememories fade

37
Q

What is the first thing to address in Coverage part

A

Insuring clause + clause on whether occurrence or claims made policy - go through definitions to see if within

38
Q

Fourth figure in reserve table

A

Subtotal

39
Q

What should go in facts of claim

A

Briefly identify issues and provide appropriate summary

40
Q

Second figure in reserve table

A

Costs (Claimant)

41
Q

Final part of Coverage

A

Consider if claim exceeds policy limit - insured self-insuring/excess insurers?

42
Q

If insurers decide to deny liability, advise insurer to do what

A

Write to insured immediately to advise them and require that they act as a prudent uninsured and deal w/ Claim on best terms possible and seek independent legal advice

43
Q

What is an IBNER reserve

A

Claims incurred but not enough reported - likely to change w/ more info

44
Q

What three separate figures are provided for in the reserve

A

Indemnity, defence costs and S own fee

45
Q

Who is an initial report prepared for

A

Both insurer and insured, but different content

46
Q

After going through policy limit in report, what next in Coverage

A

Notification clause (CP? what is effect?

47
Q

Two ways to carry out subrogation against culpable 3rd

A

Joining to main action or dealing w/ after main action against insured settled

48
Q

What is a split trial

A

Insurer settles on issue of liability but reserves position on quantum of claim

49
Q

What is an open claim reserve

A

Claims made + being investigated/processed

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