C4 Flashcards
What is the Claims Handling process?
Notification Review Response to Claimant Claim investigation Claim negotiation Claim settlement Recoveries Review
Personal Insurance
Motor Cars Personal Injury Health Household Buildings Travel Extended Warranties Creditor Insurance
Commercial Insurance
Property
Private Motor Cars Claims Process
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
Personal Injury Claims
Dealt with under the Personal Injury Pre-Action protocol
Health Claims
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]
Household Claims
2 categories
1) Durable Goods (eg. household furniture) NEW FOR OLD BASIS
2) Consumer Goods (eg. curtains clothes)
Buildings Claims
Usually settled be repairing buildings
Travel Claims
Depends on which section of the policy the claim is being made from
Extended Warranties
Because no cash incentive, a settlement would result in the covered appliance being repaired or repalced
Creditor Insurance
provides protetcion in event policyholder can’t repay a loan due to disability or losing their job or death - needs proof
Property Claims: Fire & Special Perils
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
All Risks Claims
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
Theft Claims
insured must notify the appropriate authorities of the theft & insurers often request a copy of the police report
Glass Claims
tend not to be overstated so invoice from approved repairer will be sent directly yo the insurer
Money Claims
standard investigation
will request proof money was on premises; details of occurrence & confirmation that the matter has been reported to authorities
Pecuniary Insurances: Legal expenses
insured has obligation to notify their insurers before action is commenced & so insurer can take any steps they deem appropriate eg. Appoint own solicitors
BI
: 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
Public Liability
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
Professional Indemnity
policies protect the insured against their legal liability towards 3rd parties for injury, loss or damage arising from their own professional negligence
Professional Indemnity is usually made on a
claims-made basis
public / EL policies written on a?
losses-occuring basis
Questions asked on a claims-made basis policy
1) When was the claim made?
2) Was it in accordance with the policy terms?
3) Did insurance cover exist at the time
Questions asked on a losses-occurring basis?
1) When did the loss occur?
2) Did insurance cover exist at that time?
How are most small motor, EL & PL in jury claims dealt with?
Electronically using the claims portal
Commercial Vehicles
Insured will often arrange & pay fro repairs & submit invoice to insurers for settlement net of the excess
What related claims services are there?
Legal helplines & advice
Why are authorised repairers used?
Benefits for insurers = convenience, price reduction & competence
Uninsured loss recovery services
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
No win no fee
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
ATE
After the Event legal expense cover
What does ATE do
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
Risk Management
Risk controls can be PHYSICAL or FINANCIAL
Physical control
Risk Avoidance – abandoning prospective cause of a loss
Risk Reduction - practical measures to reduce frequency & severity
Financial control
Risk Retention - policyholder meets cost of losses itself
Risk transfer - insurance
Combination
Rehabilitation
medical, vocation, qualitative
