5 Handiing and Settlement Flashcards
Key aspects of claims process TACC
Timely
Actively managed
Cost efficient
Correct decision
Considerations for international claims
Different legal systems Codes of practice different timescales training needs language / cultural
Insurance fraud CUSE
Underwriting
Claims
Staged
Exaggeration
Case law fraud - Britton
No loss
Case law fraud - Barnes
False evidence
Identifying fraud - clues from loss
Inconsistencies
unrealistic
large £
Identifying fraud - clues from policyholder
familiar with process
prior contact to check cover
vague about loss
previous claims
Identifying fraud - clues from policy
increased cover
delay making claim
after loss, policy cancelled
Identifying fraud - clues from documentation
docuementation looks unprofessional
Details don’t exist
Signatures different
Fraud registers
Art Loss Register Mylicence CUE Motor Insurers Anti Fraud and Theft Register National Plant and Equipment Register Insurance Fraud Register
Which act deals with remedies for fraud?
Insurance Act 2015
Which section of IA2015 deals with remedies
s.12
Does the IA2015 only apply to 1st part fraud? Yes/No
Yes
Remedies under IA2015 for fraud
Insurer not liable Recover sums Treat contract terminated from fraud act Keep premium (claims prior to fraud must be covered though)
Criminal Justice and Courts Act - which section for PI claims
s.57
s.57 allows dismissal of claim where….
fundamental dishesty can be shown
If fundamentally dishonest then…
dismiss entire claim + costs (less amount of genuine claim)
Subrogation brought in name of…
Policyholder (except riot compensation act)
Subrogation must be brought in single claim? Yes / No
Yes
Express subrogation clause does what?
Allows insurers to bring proceedings against 3rd party before claim is settled
what does contractual waiver do?
insurer agrees not to exercise subrogation against certain other parties.
Contribution arises when:
Two policies Both cover subject matter Both cover peril Both cover interest Both are liable
Rateable proportion clause
responsible for proportion of loss only if other policy exists
Two methods for calculating contribution
Independant liability method
Maximum liability method
Market agreements reduce
disputes and admin costs
Abandonment definition:
Insured gives up subject matter
Salvage
insurer takes over subject matter
Actual total loss
subject matter destroyed or owner deprived of it
Constructive total loss
insured is deprived of ship
Constructive total loss requires insured to serve notice of abandonment? Yes / No
Yes
Constructive total loss is for marine only?
Yes
