C4

Question 1

What is the Claims Handling process?

Answer 1

Notification 
Review
Response to Claimant
Claim investigation
Claim negotiation 
Claim settlement 
Recoveries 
Review

Question 2

Personal Insurance

Answer 2

Motor Cars 
Personal Injury 
Health 
Household 
Buildings 
Travel 
Extended Warranties 
Creditor Insurance

Question 3

Commercial Insurance

Answer 3

Property

Question 4

Private Motor Cars Claims Process

Answer 4

1) insured has to report ALL accidents
2) insured may have to complete ARF (accident report form)
3) insurer sets up file
4) insurer establishes whether policy is in force & if there is a claim
5) any other claims are reviewed
6) 3rd party claims
7) If 3rd party injured that is sorted

Question 5

Personal Injury Claims

Answer 5

Dealt with under the Personal Injury Pre-Action protocol

Question 6

Health Claims

Answer 6

1) Insurer checks the contract is valid & conditions met
2) Supporting evidence provided [dead = death certificate; loss of limb = evidence; disabled = medical certificate & registered doctor]

Question 7

Household Claims

Answer 7

2 categories

1) Durable Goods (eg. household furniture) NEW FOR OLD BASIS
2) Consumer Goods (eg. curtains clothes)

Question 8

Buildings Claims

Answer 8

Usually settled be repairing buildings

Question 9

Travel Claims

Answer 9

Depends on which section of the policy the claim is being made from

Question 10

Extended Warranties

Answer 10

Because no cash incentive, a settlement would result in the covered appliance being repaired or repalced

Question 11

Creditor Insurance

Answer 11

provides protetcion in event policyholder can’t repay a loan due to disability or losing their job or death - needs proof

Question 12

Property Claims: Fire & Special Perils

Answer 12

1) Insured must notify insurer immediately
2) Mitigate losses
3) Deliver full information about property loss & provide proof of loss
4) insurer establishes if policy & claim is valid & if policy covers the loss

Question 13

All Risks Claims

Answer 13

1) Insured must notify insurer immediately
2) Mitigate losses
3) Deliver full information about property loss & provide proof of loss
4) insurer establishes if policy & claim is valid & if policy covers the loss

Question 14

Theft Claims

Answer 14

insured must notify the appropriate authorities of the theft & insurers often request a copy of the police report

Question 15

Glass Claims

Answer 15

tend not to be overstated so invoice from approved repairer will be sent directly yo the insurer

Question 16

Money Claims

Answer 16

standard investigation
will request proof money was on premises; details of occurrence & confirmation that the matter has been reported to authorities

Question 17

Pecuniary Insurances: Legal expenses

Answer 17

insured has obligation to notify their insurers before action is commenced & so insurer can take any steps they deem appropriate eg. Appoint own solicitors

Question 18

BI

Answer 18

: covers insured’s loss of profits following damaged by an insured peril- UNIQUE – at proposal stage qns asked about how the proposer will react in the event of a claim eg. Have they got alternative premises? How soon can they get up and running? Is there a detailed disaster recovery plan? Insurer can participate here because the indemnity period is selected & represents the MAX length of the claim

Question 19

Public Liability

Answer 19

policies cover loss of or damage to 3rd party property and / or 3rd party injury caused by the insured’s negligence or beach of statutory duty

Question 20

Professional Indemnity

Answer 20

policies protect the insured against their legal liability towards 3rd parties for injury, loss or damage arising from their own professional negligence

Question 21

Professional Indemnity is usually made on a

Answer 21

claims-made basis

Question 22

public / EL policies written on a?

Answer 22

losses-occuring basis

Question 23

Questions asked on a claims-made basis policy

Answer 23

1) When was the claim made?
2) Was it in accordance with the policy terms?
3) Did insurance cover exist at the time

Question 24

Questions asked on a losses-occurring basis?

Answer 24

1) When did the loss occur?

2) Did insurance cover exist at that time?

Question 25

How are most small motor, EL & PL in jury claims dealt with?

Answer 25

Electronically using the claims portal

Question 26

Commercial Vehicles

Answer 26

Insured will often arrange & pay fro repairs & submit invoice to insurers for settlement net of the excess

Question 27

What related claims services are there?

Answer 27

Legal helplines & advice

Question 28

Why are authorised repairers used?

Answer 28

Benefits for insurers = convenience, price reduction & competence

Question 29

Uninsured loss recovery services

Answer 29

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

Question 30

No win no fee

Answer 30

Where successful in purusing a claim, the accident management company is entitled to a percentage of the recovery - these agreements are clled CONDITIONAL FEE AGREEMENTS

Question 31

ATE

Answer 31

After the Event legal expense cover

Question 32

What does ATE do

Answer 32

underwrites possibility that the court action will be unsuccessful;premium paid to insurer & policy guarantees payment of the legal costs associated with the prosecution of a claim

Question 33

Risk Management

Answer 33

Risk controls can be PHYSICAL or FINANCIAL

Question 34

Physical control

Answer 34

Risk Avoidance – abandoning prospective cause of a loss

Risk Reduction - practical measures to reduce frequency & severity

Question 35

Financial control

Answer 35

Risk Retention - policyholder meets cost of losses itself
Risk transfer - insurance
Combination

Question 36

Rehabilitation

Answer 36

medical, vocation, qualitative