CH : 11 Valid Claims and claims Settlement Flashcards
Claim is the ….result of insuring
Tangible
People take out insurance because they worry about the
Possibility of misfortune
What kind of claim must be commenced within the requisite time scale after the incident ir event as set out
Formal Claim
What is a limitation period
Is a fixed period of time during which formal civil proceedings must be started.
The limitation periods under the civil law of Wales and England are fixed by the
Limitation Act 1980
What is the reason for limitation period
Public policy
In a personal injury claim involving a child when will the limitation period will start
It does not start to run until the child reaches the age 18 and will run until his 21st birthday
When can the statutory limitation date may be overridden under the section 33 of the Act
At the court discretion
When personal injury claim must be commenced in the courts
Within 3 years of the date of accident or incident or 3 years from the date of knowledge
Which type of claims the limitation act 1980 applies
Only civil claims
Limitation period varies depending on what factor ?
Type of civil claim involved
The statutory limitation date may b overridden under sec .33 of the act
At the courts discretion
Under Personal Injury when should a claim must be commenced in the courts
Within 3 yrs of the date the accident or incident occurred OR 3 yrs from the date of knowledge.
On which acts there are no statutory limits on the prosecution of crimes in the UK except for summary offences
Criminal Acts
When should the criminal proceedings must be brought in
Within 6 months
On whom does the onus of proof rests
Insured
Whos responsibility is to prove that they have a valid claim
Insured
2 things insured provide to prove they have a valid claim
1.that an insured peril arose
2.the amt of the loss
When does the position changes from.insured to insurer in terms of onus of proof
If an insurer wishes to decline to pay a claim because of the operation of the exclusion in the policy terms
In which cases an insurer may provide less than a full indemnity
Insurers choice ( as in the case of a first loss policy )
2.imposed policy term ( compulsory excess )
3.poor insurance arrangements
If the measurement of indemnity following a loss is greater than this sum or limit than the insured recovery is limited to the
Sum insured or limit of indemnity
When do we apply average clause
Where an insured under values the risk insured
Average clause means
Paying proportion of the insured loss when there is under insurance
What is ex gratia payments
Made out of favour
When do insurer do not possess subrogation rights
If insurer makes payment out of ex gratia
Two types of duties of the insured after a loss
Implied duties
Express duties
Which implied duties if not performed will be considered invalid
1.all reasonable steps to minimise the loss
2.advise the appropriate authorities in the event of loss
3.take all steps to prevent a loss from spreading
4.not hinder the insurer in the claims investigation process.
What is express duties
Are duties written into the contract and are usually found as the claims conditions in the policy
In which condition it will allow the insurer to repudiate any particular claim
Claims conditions in the policy
Another name for claims procedure or action by the insured
Notification condition
What is claim procedure
A condition that sets out the duties of the insured on teh happening of the event insured against
What identifies the action required by the insured
The condition
Practice varies considerably regarding the completion of
Claim forms
In motor insurance the form to be filled at the time of loss is called as
Accident report form
Who is claimant
The insured who is making a claim
For larger or more complicated claims ..who is been approached
Loss adjuster
Supporting evidence required for personal injury and sickness claims
Medical evidence or doctors cert.
Supporting docs requited for motor claims
Vehicle registration documents
Supporting docs required for theft claims
List given by the insured to the police in order to compare with the list mentioned in the claim form
Who are loss adjuster
Are independent and professionally qualified ..and their fees are paid by the insurers
Who do not usually accept instructions to act on behalf of the general public
Loss adjusters
Who act on behalf of insureds interest alone
Loss assessor
The assessors fees is paid by the
Insured
Under which principle of insurance the insured is not allowed to claim more than the true amount of the loss
Indemnity
The right of an insurer to call another insurer to share the loss of an indemnity payment
Contribution
Contribution right only applies to
Policy of indemnity
What is Principle of Contribution
Allows the insured to claim the full loss from one insurer who then has the right to ask other insurers who are liable to share the claims payment
At common law, who has the option of claiming the whole sum from either insurer with insurers then having to share the loss between themselves
The insured
Which principle of insurance is always modified
Contribution (found in all non marine policies of Indemnity )
Who is obliged to claim proportionately
The insured
Formula to calculate claim subject to contribution
Sum insured by ind insurer ÷ TSI × loss = insurers liab
The condition of average can only apply to
Property insurances that have a Sum Insured
Clause effectively recognises that the valuation of certain property can vary during the policy period
Average relief clause or special condition of average
