Aspects of claims process and related claims services Flashcards
Step 1
What is the insured bound by notification policy condition?
to report all accidents.
When does this apply?
This applies whether or not they intend to claim or expect a third party to claim against them.
Step 2
When is the insured required to complete an accident report form?
At the notification.
At notification, the insured may be required to complete an accident report form (ARF), which could be done:
Over the telephone or internet.
Step 3
When will the insurer set up a file?
After receiving necessary information.
This is likely to be electronic and no longer a physical paper file.
True
Step 4
What will the the insurer firstly establish when claim is to be made?
Whether a policy is in force and whether the insured is entitled to an indemnity.
When may the claim be investigated?
Depending on the nature and size of the claim.
This could be done as a desktop exercise by the insurer
True
A claims investigator or loss adjuster may interview the drivers and witnesses, as well as:
Visit the accident scene.
If there is a valid claim, repairs to the insured’s vehicle will take priority.
True
The repairs are often carried out at the insurer’s own authorised repair centres.
True
Step 5
Claims under other sections of the policy will be reviewed as necessary.
True
Property in the vehicle that was damaged in the accident:
Is reviewed as necessary
Step 6
A third party may claim for damage to their vehicle or there may be damage to other property.
True
The third party will generally be required to submit estimates for the repair or replacement of the damaged items.
True
The insurer will consider and either approve or renegotiate, the third party indemnity, repair or replacement for damaged items caused by the insured.
True
The insurer will establish who was at fault or ascertain the degree of negligence by each party.
True
As a way of controlling costs, if the insured is at fault:
the insurers may offer to proactively handle the third party claim.
True
Step 7
If a third party is injured in the accident, claims can be:
Complex and costly to settle.
The degree of negligence must be established before consideration is given to the extent of the injury, the medical prognosis, and other relevant considerations.
True
Whether the claimant was unable to work, or had required care whilst incapacitated: is information that needs analysis by:
Claims handler
Who must place an accurate valuation against the injuries in line with current damages awards made by the courts?
Claims handler
Why does the claims handler go through all the trouble to place accurate valuation?
in order to negotiate settlement of the claim.
Class-specific claims matters to provide an insight into the varying characteristics of the claims processes.
True
For instance:
A simple rear-end collision
motor claim in which no-one was injured. This could be settled in a few days if the insurer were proactive.
True
But for instance:
A fatal accident under a liability policy, which may take years to resolve and would require a different level of sophistication and expertise.
True
Claims process flowchart ??
Notification Review Response to claimant Claim investigation Claim negotiation Claim settlement Recoveries Review
The considerations for both cars and motorcycles will be the same, subject to certain policy differences.
True
Where the insured has non-comprehensive cover (i.e. third party, fire and theft, third party, only or RTA only), they must:
still,
Report the incident to their insurer as one of the claims conditions.
The insurer will take no further action in respect of any damage to the policyholder’s own property, because they have no cover for this.
True (in a non comprehensive cover if the insured damages his own car)
The insurer would ONLY deal with third party claims, subject to liability.
True (I.E. NON Comprehensive Cover)
The insured would have to make a claim against the responsible party or their insurer where they would be dealt with as the ‘third party’ as discussed above.
True (I.E. NON Comprehensive Cover)
Where an insured has comprehensive cover and has a claim against a liable third party, their insurer would utilise the subrogation condition in the policy to recover the costs they have incurred.
True (i.e. Comprehensive cover)
Question 4.1
What rights does the subrogation clause give the insurer?
The insurer the right to stand in the place of the insured before paying their claim enhancing the common law to claim against third party.
For the money already paid out to its insured.
What do Health claims regard?
Personal accident and sickness policies.
The handling of such claims is vastly different from those under indemnity policies.
True
They are benefit policies and the settlement figure has already been agreed at policy inception.
True
When a health claim is submitted, the insurer will check that a valid contract was in force and that the policy conditions have been met.
True
The appropriate supporting evidence must be provided:
If the insured :
has died as a result of an accident or sickness, there may be a coroner’s inquest and a post-mortem examination, and a death certificate must be provided;
suffered the loss of a limb or limbs, sufficient proof must be provided; and
is temporarily or permanently disabled, they must provide a medical certificate and be in the care of a registered doctor.
The insurer may wish to involve its own medical representative to confirm the extent of any illness or disablement.
True
Why are personal accident and sickness policies always benefit policies rather than policies of indemnity?
The loss of limb or health is something that is impossible to put a financial value on and insurances provide for the payment of a pre agreed sum.
Household contents are divided into two categories:
Durable goods
Things like household furniture, refrigerators and freezers, etc.
Consumer goods
Less durable items that are likely to wear out more quickly, such as curtains, towels and clothing.
Most insurers will state in their policy wordings that claims for durable goods are generally settled on a
‘new for old’ basis.
This means that damaged goods will be replaced by new items, rather than the claim being settled on an indemnity basis.
True (‘new for old’ basis.)
Claims for consumer goods are generally settled as new for old or on the basis of the cost of replacement, less wear and tear, according to their age.
True (‘new for old’ basis.)
A claims settlement on this latter basis is more likely to lead to disagreements between the insurer and the policyholder, unless the policyholder’s expectations are well managed.
True (‘new for old’ basis.)
Claims under the buildings section of the household policy are usually settled by repairing the buildings.
True (Buildings Insurance)
The indemnity sum for the loss or damage to the buildings has been calculated as the cost of repair or reinstatement at the time of loss less an allowance for betterment.
True (Buildings Insurance)
Who is usually used to provide an expert’s opinion as to any substantial damage?
Loss adjuster
Betterment arises when certain aspects of the repaired property are in a better condition than:
they were before the loss
(for example, the installation of new wiring) or the repaired/ replaced article is better than the original one was when new, e.g. double glazing replacing an old single-glazed window.
True (Betterment)
Think back to the definition of ‘indemnity’. Why is an allowance for betterment subtracted from the indemnity sum?
The principle of indemnity states that the insured must be placed in the same financial position after a loss they enjoyed before the loss, and such improvements to their property would increase the value of the property, leaving the insured better off than before the loss took place, THIS IS AGAINST THE PRINCIPLE OF INDEMNITY .
The processing of travel claims will depend on which section of the policy the claim is covered.
True (Travel Insurance)
Standard Travel Insurance proof of evidence required when?:
Baggage and personal effects of money,
Medical and associated expenses,
its own enquiries with the travel authorities or ask that the insured obtains the necessary proof;
(But usually considerations that apply to health claims generally apply).
Travel interruption or delay, insurer can its own enquiries with the travel authorities or ask that the insured obtains the necessary proof,
The insurer will usually request proof of
purchase for the items claimed for, together with confirmation that the loss has been reported to the necessary authorities.
True
Claims under extended warranty policies are unlike those already discussed. A claims ‘settlement’ would result in the covered appliance being repaired or replaced.
TRUE (Extended Warranty Insurance)
Because there is no cash incentive to be gained, these policies are not subject to:
fraudulent claims as frequently as other classes,
Fraudulent claims such as:
like household or motor insurance…
It is very seldom that a claim form is even required, and a telephone call to the issuing company is usually the only action required by an insured.
TRUE (Extended Warranty Insurance)
The issuing company will then
instruct a repairer to attend the insured’s premises and carry out the necessary repairs, which can sometimes be subject to an excess?
TRUE (Extended Warranty Insurance)
Pet insurance is available to cover injury, loss or illness of a domestic family pet (such as, a cat or dog).
True (Pet Insurance)
A typical policy will cover vet’s fees required following accidental injury or illness, as well as cover for theft of the pet, boarding fees and even euthanasia costs.
True (Pet Insurance)
In the case of dogs, the policy can be extended to cover liability caused by the animal, should it bite or cause injury to another person.
True (Pet Insurance)
Commercial insurances will cover:
Commercial vehicle claims ,
Liability claims employers’, public, products, and professional indemnity
Pecuniary claims legal expenses, and business interruption.
Property claims such as fire and special perils, all risks, theft, glass, and money
Property claims such as
Fire and special perils,
In the event of loss or damage, the insured has a duty to:
the amount of damage, in writing,
deliver to the insurer full information about the property lost, destroyed or damaged
mitigate their losses, i.e. carry out, or permit to be carried out, any reasonably practical action to prevent further damage
notify the insurer immediately;
provide proof of loss (e.g. a builder’s estimate for repair) and,
if required, complete a statutory declaration of the truth of the claim
The insurer would then establish the following.
- Whether the policy is in force,
- Whether the claim is valid
(i. e. an insured peril caused the loss) - Whether the policy covers the loss
If the claim is large, the insurer will usually appoint:
an independent loss adjuster.
What does The loss adjuster do?
investigates the loss and prepares a report recommending the amount payable, under the terms of the policy,
investigates the cause of the loss as well as its extent, and ensure that the insured has complied with any related endorsements or warranties.
The loss adjuster advises on any recovery prospects.
True (Loss Adjuster) in investigating in large / complex claims .
The insured may appoint a loss assessor to act on their behalf and negotiate with the adjuster and/or the insurers.
True
Negotiations between the insured loss assessor and the insurer loss adjuster
Sometimes, a monetary payment is made.
Otherwise, the insurer may exercise its options by reinstating the building or replacing, repairing or restoring the property, as appropriate.
True. (exercising options of the insurer)
All risks claims::
The procedure for claims here is the same as that described for fire and special perils insurance.
True (All RISKS claims similar to FIRE and Special perils insurance)
For larger claims, an insurer usually appoints:
a loss adjuster who will ensure that the claim is valid and negotiate settlement on the insurer’s behalf.
In Theft claims the insurer requires the insured:
to notify the appropriate authorities, i.e. the police, of the theft.
Insurers often request a copy of the police report and, especially with larger claims, appoint a :
loss adjuster.
if fraud is suspected the insurer will usually appoint :
a specialist claims investigator.
The insurers then usually liaise with the police so that, if the stolen goods are recovered,
the insurer can claim them as salvage.
In Glass claims It is usual for insurers to
have approved repairers for these claims.
As there is little financial incentive to be gained and claims can rarely be ‘overstated’, when the insurer has satisfied itself that the claim is covered, repairs will usually be authorised.
True (Glass claims= Authorised Repairers)
The invoice from the repairer will be sent directly to the insurer.
True (the Authorised repairers)
Glass claims are usually subject to an excess to avoid small claims.
True (Glass Claims)
In Money insurance policy, when the insurer has completed its standard investigations in respect of cover, it will request:
Proof of loss, (In Money Insurance)
What else would the insurer request?
Confirmation that the matter has been reported to the authorities,
details of the occurrence,
proof that the money, cheques or stamps etc. were on the premises
There is great scope for abuse here, and insurers will want assurance that:
there is no fraud involved.
Money Insurance
If necessary, specialist investigators will be enlisted to assist their enquiries.
True
as there is great scope of abuse, and to ensure that there is no Fraud involved
Pecuniary insurance in (Legal expenses claims),
these policies are different from other claims, because an insurer can assess its potential liability before the claim commences.
True (Pecuniary insurance) in (Legal expenses claims),
The insured has an obligation to
notify their insurers before action is commenced and the insurer can then take any steps it deems appropriate.
True (Pecuniary insurance) in (Legal expenses claims),
This includes things such as :
appointing its own solicitors and, if
appropriate,
co-operating with the insured in attempting to reach a settlement before the court action starts.
Business interruption (BI) insurance covers the insured’s loss of profits following damage to their property caused by the action of an insured peril.
True (Business Interruption)
Consequently, there is always a property damage proviso in a business interruption policy,
True (Business Interruption)
Meaning that the underlying property must be insured before an interruption policy is issued.
True (Business Interruption)
Both policies are usually with the same insurer and the BI claim will be run in conjunction with the property damage claim.
True (Business Interruption run in conjunction with the property damage claim).
(Which needs to be in place BEFORE BI insurance comes into play)
BI claims are unique, in that at the proposal stage questions are asked about how the proposer will react in the event of a claim…
True (Business Interruption)
Examples of such questions would be:
- have they got alternative premises;
- how soon can they get up and running; and
- is there a detailed disaster recovery plan?
The insurer can ‘participate’ in the claim here because, unlike any other type of claim, :
the indemnity period selected (usually 12, 24 or 36 months) represents the maximum length of the claim.
The insurer can, and often does, have:
representation to minimise the loss.
Creditor insurance provides protection to the policyholder in the event that they are unable to:
repay a loan due to their death, disability or losing their job.
Therefore, before settling any claims on a creditor insurance policy the insurer will require:
evidence of the payments that the insured needs to make.
proof that the insured is not working;
Liability losses are claims arising out of legal liability for incidents involving injury to third parties (including employees) or damage to their property.
True (Liability Insurance in general)
Which act made employers’ liability insurance compulsory in the UK?
The Employers’ Liability Compulsory Insurance Act 1969
This insurance covers :
indemnity against bodily injury or
disease sustained by the insured’s employees arising out of, and in the course of, their employment.
It is common for this policy to be combined with a public liability policy.
True
Employers Liability
Which clime are a particular concern in industries with a high incidence of accidents or disease, e.g. mining?
Employers’ liability claims
Public liability policies, cover:
loss of or damage to third party property and/or third party injury caused by the insured’s negligence or breach of statutory duty.
Public liability policy is often combined with:
Product liability insurance,
Which policy provides the same cover, but for losses arising out of the sale or supply of the insured’s product.
Product liability policy
Which policy protects the insured against their legal liability towards third parties for injury, loss or damage arising from their own professional negligence, or that of their employees.
Professional indemnity policies
Negligent misstatements or a breach of the common law duty of care are?
Professional indemnity policies
Professional indemnity insurance is generally written on:
a claims- made basis.
Meaning that provided a claim is made during the period of insurance?
It does not matter when the event leading to the loss took place.
For this reason, it is important for professional indemnity claims adjusters to consider:
Whether the policy was in force at the time the claim was made against the insured.
The exact claims notification required depends on the policy terms.
True (Professional indemnity insurance)
It is also common for product liability policies to be written on:
a claims-made basis,
Which policy can be ALSO written on an occurrence basis as well??
Product liability insurance
Public and employers’ liability policies are usually written on a losses-occurring basis.
True
For policies written on a claims-made basis the questions are:
When was the claim made?
Was it in accordance with the policy terms notified to the insurer?
Did insurance cover exist at that time?
For policies written on a losses occurring
basis, the questions are:
When did the loss occur?
Did insurance cover exist at that time?
Once the insurer is satisfied that the loss is covered within the policy period a full investigation will be carried out. This will include:
description on the policy schedule;
interviewing any witnesses,
investigating what work was being carried out and
whether it was included within the business,
obtaining all relevant documentation.
From 31 July 2013
The MOJ/Claims Portal was extended to incorporate:
employers’ and public liability claims with a value up to £25,000, where the accident date is on or after 31 July 2013.
For claims up to £10,000, the maximum amount recoverable for legal costs by
successful claimant solicitors is £900 plus VAT.
True (The MOJ/Claims Portal )
For claims between £10,000 and £25,000 it is £1,600 plus VAT, assuming the claim does not leave the process, nor proceed to litigation.
True (The MOJ/Claims Portal )
These procedures do not apply to employers’ liability claims involving multiple claimants alleging disease type injuries, such as noise induced hearing loss
True (The MOJ/Claims Portal )
Who has recommended that fixed costs are introduced for noise induced hearing loss claims?
Civil Justice Council
In practice, the insurer negotiates directly with the third party or their representative.
True
The insured must immediately pass any claim made against them to their insurer, in accordance with the policy terms.
True
For third party property damage, who investigate the facts of the case and reach a decision on liability.
Insurers
The investigation by the insurer include :
a request for a written report of the negligence alleged against the insured,
evidence to support the amount of the claim,
if required, an inspection of the damaged property.
Claims involving personal injury usually come from the:
third party’s solicitors,
who will obtain a medical report on the injury. ?
third party’s solicitors,
Damages are paid to the claimant under two headings as follows:
Special damages :
those losses that can be quantified
(e.g. medical expenses, future loss of earnings)
General Damages:
Less tangible losses,
such as compensation for pain, suffering and loss of amenity (PSLA) and loss of use of vehicle.
Some cases proceed to court, and once in court a judge may:
allow a periodic payment which provides pre-determined sums at certain dates in the future.
allow a structured settlement, which provides an income to the claimant over a period of time,
award a single lump sum payment,
make a decision that allows for a reassessment after a period of time.
These actions are from the judge::
To allow periodic payment, pre determined sums in future,
Allow structured settlement, income for claimant over period of time,
Award single lump sum payment,
Make decision that allows for reassessment after period of time,
Commercial vehicles claims considerations are essentially the same as for private motor vehicles.
True
The insured will often arrange and pay for the repairs and then submit the invoice to their insurers for settlement, net of the excess, why?
Many commercial vehicles require
specialist repair, which may not be available at the insurer’s authorised repairer.
There are a variety of Related claims services that can be utilised in the claims handling and settlement
procedures, these are:
authorised repairers; legal costs service; legal helplines; rehabilitation. risk control/advice; and uninsured loss recovery services
A legal helpline is an advisory and/or assistance service provided by telephone. They are usually free to the user, and often operate 24 hours a day.
True (Legal helplines)
What is the emphasis of Legal helplines and advice on?
immediate practical action, which has the benefit of meeting customer expectations.
Advisers will guide a policyholder through the legal process in a practical way.
(Legal helplines)
The helpline can help the insured pursue or defend a claim.
True
Legal helplines often act as the first notification of loss (FNOL) stage for claims under legal expenses insurance policies.
True
Legal helpline in legal expenses insurance
Advisers will have an understanding of the cover provided and whether there is a claim which can be settled by the insurer.
True
Insurers will often negotiate with various suppliers and/or repairers to provide services at a discounted rate, and at an agreed standard. What is this example of?.
Authorised repairers
What benefits the provider, the insured and the insurer?
Authorised repairers
Which contractors or suppliers are termed approved or authorised repairers?
When insurers negotiate with various suppliers and/or repairers to provide services at a discounted rate, and at an agreed standard.
Motor insurance has the most prevalent use of approved repairers.
True
Approved Repairers in Motor Insurance
if a vehicle is not driveable, how are Tow ins arranged?
approved repairers
As advanced technology is becoming more commonplace, artificial intelligence tools being introduced:
to assess if the vehicle is repairable..
What are ‘uninsured losses’?
Are those losses that an insured may suffer that are not directly covered by
a policy of insurance relevant to an insured event.
What other uninsured losses could arise as a result?:
the cost of a hire vehicle;
the cost of alternative transport, e.g. buses, trains
loss of earnings
loss of use (where a replacement vehicle cost was not incurred);
personal injury;
Some provide help with recovering uninsured losses, but practices vary widely, such as :
insurance intermediaries
Most insurers and intermediaries offer legal expenses insurance, which provides for the instruction of solicitors to recover uninsured losses.
True
There is usually an indemnity limit on the level of legal costs which the policy will cover, for example:
£50,000.
What are the principal/main benefits of a panel of approved repairers to motor insurers?
competence (as mentioned, approved repairers are vetted first and continuing quality control and monitoring takes place).
convenience;
cost (a price reduction on labour and parts will normally be negotiated);
An insurer may agree to attempt to recover an insured’s :
policy excess from a liable third party or their insurers.
The use of equipment such as digital cameras mean that an insurer’s engineer need NOT attend the repairer’s premises to ‘inspect’ each vehicle and authorise repairs.
True
a panel of approved repairers to motor insurers
The repairer will email the photograph or video clip of the damage to the insurer, which can then authorise the repair.
True
a panel of approved repairers to motor insurers
However, spot checks and audits are common.
True
a panel of approved repairers to motor insurers
As advanced technology is becoming more commonplace, artificial intelligence tools being introduced:
to assess if the vehicle is repairable..
What are ‘uninsured losses’?
Are those losses that an insured may suffer that are not directly covered by
a policy of insurance relevant to an insured event.
What other uninsured losses could arise as a result?:
the cost of a hire vehicle;
the cost of alternative transport, e.g. buses, trains
loss of earnings
loss of use (where a replacement vehicle cost was not incurred);
personal injury;
Some provide help with recovering uninsured losses, but practices vary widely, such as :
insurance intermediaries
MOST insurers and intermediaries offer legal expenses insurance, which provides for the instruction of solicitors to recover uninsured losses.
True …
Legal expenses are usually purchased with a motor policy to provide cover for these occurrences.
True
Legal expenses purchased with Motor Insurance
The wordings of such policies vary, but TYPICALLY, provide an indemnity for legal expenses incurred in pursuing an uninsured loss claim, where reasonable prospects exist.
True
Legal expenses that is purchased with a motor insurance policy when pursuing UNINSURED LOSS CLAIM
At one time, if the claim was successful, the premium for the ATE cover could be recovered from:
the defendant.
Who prohibited the recovery of the ATE insurance premium from the paying
party and introduced qualified one way costs shifting as a balancing measure?
The Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO),
An insurer’s recovery team will usually ONLY try to recover the outlay they incurred.
True…
Insurer recovery team
However, that does NOT mean that the two are always exclusive.
True…
NOT always exclusive
Qualified One Way Cost Shifting purpose?
A claimant has a minimal cost risk when taking a genuine claim to a court
hearing as, should they not succeed, they would not have to pay the defendant’s legal costs. (as was technically the case previously).
Claimant legal costs are also likely to be met by:
ATE legal expenses policy if the claim is unsuccessful.
What is A conditional fee agreement?
(a ‘no win, no fee’ agreement)
is one in which a solicitor and client agree to share the risk of litigation by arranging a success fee.
How is the CFA agreement calculated?
Calculated as a percentage of the solicitor’s legal fees, which will be payable by the client in the event of success.
What is calculated as a percentage of solicitor legal fees and payable by the client in the event of success?
Conditional Fee Agreement.
What is A damages based agreement (DBA)?
an agreement under which the client agrees to pay a percentage of sums recovered, not necessarily in lieu of costs. This is also capped at 25% of general damages.
What is an agreement in which the client agrees to pay a percentage of sums recovered, and capped 25% of General Damages ?
Damages based agreement
Who changed the law to enable a non-lawyer to own a legal practice.
The Legal Services Act 2007
What is the result of the The Legal Services Act 2007 in conjunction with the advent of LASPO ACT 2012?
the creation of hybrid companies which allow insurers to refer their own customers to a law firm which they have an interest in, for the purposes of pursuing uninsured losses.
credit hire and personal injury are examples?
of uninsured losses.
Who made changes to the small claims track (SCT) limit for personal injury claims?
The Civil Liability Act 2018,
When did the The Civil Liability Act 2018 make this change?
when implemented
What did the The Civil Liability Act 2018 also change?
the landscape once more for some types of claims.
Why do companies use ‘risk management’?
to control the risks that impact their business.
What is one of the three main elements of risk management.
Risk control
What are the other two?
risk identification (which involves identifying the actual risks of loss that the company faces) and risk measurement (which involves evaluating the cost to the company of a particular risk coming into play).
Which element of risk involves evaluating the cost to the company of a particular risk coming into play?
Risk measurement
Which element of risk involves identifying the actual risks of loss that the company faces?
Risk identification
What is Risk control concerned with?
minimising the adverse effects of an event, if and when it occurs.
Risk controls may be either:
- financial; or
* physical.
This they could do through:
risk retention;
• risk transfer; or
• a combination of both.
What is Risk retention?
is when a policyholder decides to meet the cost of its losses itself.
How can a policyholder perform risk retention?
by simply paying for losses out of its own cash flow as (when losses occur),
What other ways can a policyholder perform risk retention?
by setting up a captive insurance company or by building up a separate fund which can then be used to meet the cost of any losses aka (self-insurance).
What does Risk transfer mean?
The responsibility for meeting the cost of any losses is passed on to
someone else.
What is a most common example of risk transfer?
The purchase of insurance is the most common way to transfer risk.
Physical risk control refers to?
the practical techniques that are used to reduce the frequency and/or severity of losses.
It can be done through either:
- risk avoidance; or
* risk reduction.
How can Risk avoidance be achieved?
often ONLY by abandoning the prospective cause of a loss.
How is Risk reduction achieved?
by taking practical measures to reduce the frequency and/or severity of a loss.
What are examples of risk reduction measures?
installing of sprinkler systems and fire breaks, establishing fire drills, etc.
Advice on risk control is readily available from:
insurers, brokers and specialist risk management companies.
Risk control, is mostly used in relation to?
commercial insurance.
Insurers have a vested interest in controlling the risks that have been transferred to them and will often deploy
: risk surveyors to provide technical advice to commercial policyholders.
What is Rehabilitation??
When a third party claimant has been injured and makes a claim against another who holds liability insurance, the liability insurer may wish to consider helping the injured claimant to recover by offering rehabilitation.
Why would the insurer wish to help the third party injured claimant?
early intervention with rehabilitation can
improve a claimant’s long-term prognosis, especially for more serious and catastrophic injuries.
Who places requirements on insurers to consider rehabilitation where liability attaches to a policyholder??
The Personal Injury Pre-Action Protocol
Why do Many insurers prefer to fund early rehabilitation?
Improving the claimant’s long-term prognosis and assisting their early return to work should reduce any future loss of earnings claim,
Reduction of any future loss of earnings claim is:
to the financial benefit of the insurer.
What are the three rehabilitation options???
Medical, Vocational and Qualitative.
Medical
deals directly with the claimant’s injury or disease by traditional medical methods such as surgery
A rehabilitation option that deals directly with the claimant’s injury or disease by traditional medical methods such as surgery, is an example of :
Medical
Vocational
If a return to the claimant’s pre-accident job is not possible, then vocational care helps them to find alternative employment and/or provides retraining for other employment. For example, a bricklayer losing an arm may be retrained to become a computer programmer
care that helps them to find alternative employment and/or provides retraining for other employment. Is a type of which rehabilitation option?
Vocational
Qualitative
This helps claimants to overcome their impaired capabilities to enable them to. lead as full a life as possible
Which rehabilitation option helps claimants to overcome their impaired capabilities to enable them to lead as full a life as possible.
Qualitative.
What is the aim of the aim of the Civil Procedure Rules?
to reduce cost, delay and complexity in the handling of personal injury claims and to prevent litigation where possible.
Reducing cost, delay and complexity in the handling of personal injury claims and to prevent litigation where possible are the aims of the:
Civil Procedure Rules
What’s the underlying objective of the Civil Procedure Rules?
to encourage all parties to isolate the areas in dispute as early as possible.
How’s the early settlement of disputes encouraged?
through a combination of pre-action protocols and active case management by the courts, together with cost penalties for parties who refuse unreasonably to attempt negotiation or consider alternative dispute resolution (ADR).
What are three ‘tracks’ in the courts,
- small claims;
- fast track; and
- multi-track.
There are eight pre-action protocols (PAP) with strict timetables and penalties for non- compliance.What are they?
Clinical Negligence, Construction and Engineering, Defamation, Disease and illness Judicial Review Housing disrepair Personal Injury Professional Negligence
Those are the 8 pre-action protocols with strict timetable for non compliance.
Each of these contain different information, but they all have the same basic principles and template letters.
What must be acknowledged within 21 days of receipt ?
Letter of claim
Who’s the letter of claim from?
A third party solicitor
to investigate the claim and make a decision on liability requires :
3 month period
What was introduced in 1999 and was the most important reform to be introduced into English Civil Litigation in recent times?
Personal Injury Pre-action Protocol
‘the Protocol’
All personal injury claims are managed by :
the Protocol.
It sets out the rules that the parties must adhere to in order to present and negotiate the claim, prior to issuing court proceedings.
There is an additional ‘Low Value Protocol’ in place for cases valued in the Fast Track (up to £25,000).
Low Value Personal Injury Pre-action Protocol
road traffic accident (RTA), employers liability and personal injury claims valued:
between £5,000 and £25,000,
RTA claims from vulnerable road users valued:
between £1,000 and £25,000 and
What does the Claims portal or MOJ portal control?
controls the submission and negotiation of claims between claimants and defendants.
Fixed costs apply to the various stages of the claim.
True
The staged process includes deadlines for the agreement of liability:
Stage 1: which is 15 days for RTA, 30 days for EL; 40 days for PL, as well as a set 35- day negotiation period; • Stage 2: to agree quantum; and • Stage 3: the court hearing process, where the court quickly decides on the damages either: at an oral or paper hearing.
Figure 4.1 shows the flow of the process of using the Claims Portal.
Which is :
Notification Review Response to claimant Claim investigation Claims negotiation Settlement Recoveries Review
Figure 4.2: Claims/MOJ process – basic flow
CNF sent to the insurer through MOJ Portal
Stage 1
5/30/40 days from receipt to decide liability (RTA EL PL) and out of MOJ process if liability denied or no
Response within 15 days and back to PI PAP.
Stage 2
Agree Quantum, claimant sends Stage 2 Pack with medical reports and other documents
Insurer must stage 1 costs within 10 days of receiving S2 Pack
15 days to consider offer - then a further 20 days for negotiation.
Stage 3
Court decision
If claim is agreed within Stage 2 period, pay the claim and legal costs within 10 days of agreement.
Court decision on Quantum - either oral or paper hearing.
Thousands of actions are handled annually by the relatively informal procedures of the:
small claims track in the courts.
Who governs the small claims track? the Civil Procedure Rules 1998 (CPR).
the Civil Procedure Rules 1998 (CPR).
The qualifying limit for the small claims track is:
£10,000 for property damage
claims.
Who received Royal Assent in December 2018?
The Civil Liability Act 2018
What are the consequences of this Government policy change?
Secondary legislation introduced
to change the limits for some personal injury small claims.
What is the limit is expected to rise to?
£5,000 for RTA claims with no immediate change for employers or personal liability claims.
The starting point for commencing proceedings in the small claims track is?
the N1 money claim form, which is submitted to the court with the court fee.
It should be noted that cases allocated to the small claims track are :
exempted from some procedures.
Why are cases allocated to the small claims track exempted from some procedures?
As it would burden the parties with undue formality.
There are eight pre-action protocols (PAP) with strict timetables and penalties for non- compliance.
What are they?
Clinical Negligence, Construction and Engineering, Defamation, Disease and illness Judicial Review Housing disrepair Personal Injury Professional Negligence
Low Value Personal Injury Pre-action Protocol::
Road traffic accident (RTA), employers liability and personal injury claims valued:
between £5,000 and £25,000,
RTA claims from VULNERABLE road users valued and :
between £1,000 and £25,000 and …
: and Employers Liability (EL) or Public Liability (PL) personal injury claims valued :
between £2,000 and £25,000 these are managed via an electronic portal (known as the Claims Portal or MOJ Portal),
What does the Claims portal or MOJ portal control?
Controls the submission and negotiation of claims between claimants and defendants.
The staged process includes deadlines for the agreement of liability:
Stage 1: which is 15 days for RTA, 30 days for EL; 40 days for PL, as well as a set 35- day negotiation period;
Stage 2: to agree quantum; and
Stage 3: the court hearing process, where the court quickly decides on the damages either:
at an oral or paper hearing.
This process has reduced the time it takes for low value claims to be decided from over 18 months to around 9 months.
True
agreement for liability using the MOJ portal for Low Value Personal Injury Pre-action Protocol
For soft tissue injury RTA claims presented under the Low Value Protocol there is an accreditation process for doctors providing medical reports.
True
Claims which start in the Low Value Protocol but, for a variety of reasons drop out, will fall back to the main Personal Injury Pre-action Protocol, where legal costs are also:
Fixed for claims in the Fast Track.
Thousands of actions are handled annually by the relatively informal procedures of the:
Small claims track in the courts.
Who governs the small claims track? the Civil Procedure Rules 1998 (CPR).
the Civil Procedure Rules 1998 (CPR).
The qualifying limit for the small claims track is:
£10,000 for property damage claims.
Who received Royal Assent in December 2018?
The Civil Liability Act 2018
What are the consequences of this Government policy change?
Secondary legislation introduced
to change the limits for some personal injury small claims.
What is the limit is expected to rise to?
£5,000 for RTA claims with no immediate change for employers or personal liability claims.
Implementation of the Act and other secondary regulation has been delayed and, at the time of publication, is due to be in force from April 2021.
True…
The starting point for commencing proceedings in the small claims track is?
the N1 money claim form, which is submitted to the court with the court fee.
It should be noted that cases allocated to the small claims track are :
Exempted from some procedures.
Why are cases allocated to the small claims track exempted from some procedures?
As it would burden the parties with undue formality.
This provides a speedy, effective and proportionate method of dealing with claims of limited financial value.
True….
A customer’s perception of their insurer is highly influenced by how their claim is
handled and the level of service
True
Competition from other insurers means that it is not enough simply to pay the claims accurately and efficiently.
True
Insurers seek to help their customers further by Offering other services, such as:
Risk control advice and helplines
Why do Insurers seek to help their customers further by offering such services, i.e. (Risk control advice and helplines)??
It is hoped that these services will provide more opportunity for the insurer to demonstrate its quality to its customers.
