CH : 11 Valid Claims and claims Settlement

Question 1

Claim is the ….result of insuring

Answer 1

Tangible

Question 2

People take out insurance because they worry about the

Answer 2

Possibility of misfortune

Question 3

What kind of claim must be commenced within the requisite time scale after the incident ir event as set out

Answer 3

Formal Claim

Question 4

What is a limitation period

Answer 4

Is a fixed period of time during which formal civil proceedings must be started.

Question 5

The limitation periods under the civil law of Wales and England are fixed by the

Answer 5

Limitation Act 1980

Question 6

What is the reason for limitation period

Answer 6

Public policy

Question 7

In a personal injury claim involving a child when will the limitation period will start

Answer 7

It does not start to run until the child reaches the age 18 and will run until his 21st birthday

Question 8

When can the statutory limitation date may be overridden under the section 33 of the Act

Answer 8

At the court discretion

Question 9

When personal injury claim must be commenced in the courts

Answer 9

Within 3 years of the date of accident or incident or 3 years from the date of knowledge

Question 10

Which type of claims the limitation act 1980 applies

Answer 10

Only civil claims

Question 11

Limitation period varies depending on what factor ?

Answer 11

Type of civil claim involved

Question 12

The statutory limitation date may b overridden under sec .33 of the act

Answer 12

At the courts discretion

Question 13

Under Personal Injury when should a claim must be commenced in the courts

Answer 13

Within 3 yrs of the date the accident or incident occurred OR 3 yrs from the date of knowledge.

Question 14

On which acts there are no statutory limits on the prosecution of crimes in the UK except for summary offences

Answer 14

Criminal Acts

Question 15

When should the criminal proceedings must be brought in

Answer 15

Within 6 months

Question 16

On whom does the onus of proof rests

Answer 16

Insured

Question 17

Whos responsibility is to prove that they have a valid claim

Answer 17

Insured

Question 18

2 things insured provide to prove they have a valid claim

Answer 18

1.that an insured peril arose
2.the amt of the loss

Question 19

When does the position changes from.insured to insurer in terms of onus of proof

Answer 19

If an insurer wishes to decline to pay a claim because of the operation of the exclusion in the policy terms

Question 20

In which cases an insurer may provide less than a full indemnity

Answer 20

Insurers choice ( as in the case of a first loss policy )
2.imposed policy term ( compulsory excess )
3.poor insurance arrangements

Question 21

If the measurement of indemnity following a loss is greater than this sum or limit than the insured recovery is limited to the

Answer 21

Sum insured or limit of indemnity

Question 22

When do we apply average clause

Answer 22

Where an insured under values the risk insured

Question 23

Average clause means

Answer 23

Paying proportion of the insured loss when there is under insurance

Question 24

What is ex gratia payments

Answer 24

Made out of favour

Question 25

When do insurer do not possess subrogation rights

Answer 25

If insurer makes payment out of ex gratia

Question 26

Two types of duties of the insured after a loss

Answer 26

Implied duties
Express duties

Question 27

Which implied duties if not performed will be considered invalid

Answer 27

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.

Question 28

What is express duties

Answer 28

Are duties written into the contract and are usually found as the claims conditions in the policy

Question 29

In which condition it will allow the insurer to repudiate any particular claim

Answer 29

Claims conditions in the policy

Question 30

Another name for claims procedure or action by the insured

Answer 30

Notification condition

Question 31

What is claim procedure

Answer 31

A condition that sets out the duties of the insured on teh happening of the event insured against

Question 32

What identifies the action required by the insured

Answer 32

The condition

Question 33

Practice varies considerably regarding the completion of

Answer 33

Claim forms

Question 34

In motor insurance the form to be filled at the time of loss is called as

Answer 34

Accident report form

Question 35

Who is claimant

Answer 35

The insured who is making a claim

Question 36

For larger or more complicated claims ..who is been approached

Answer 36

Loss adjuster

Question 37

Supporting evidence required for personal injury and sickness claims

Answer 37

Medical evidence or doctors cert.

Question 38

Supporting docs requited for motor claims

Answer 38

Vehicle registration documents

Question 39

Supporting docs required for theft claims

Answer 39

List given by the insured to the police in order to compare with the list mentioned in the claim form

Question 40

Who are loss adjuster

Answer 40

Are independent and professionally qualified ..and their fees are paid by the insurers

Question 41

Who do not usually accept instructions to act on behalf of the general public

Answer 41

Loss adjusters

Question 42

Who act on behalf of insureds interest alone

Answer 42

Loss assessor

Question 43

The assessors fees is paid by the

Answer 43

Insured

Question 44

Under which principle of insurance the insured is not allowed to claim more than the true amount of the loss

Answer 44

Indemnity

Question 45

The right of an insurer to call another insurer to share the loss of an indemnity payment

Answer 45

Contribution

Question 46

Contribution right only applies to

Answer 46

Policy of indemnity

Question 47

What is Principle of Contribution

Answer 47

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

Question 48

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

Answer 48

The insured

Question 49

Which principle of insurance is always modified

Answer 49

Contribution (found in all non marine policies of Indemnity )

Question 50

Who is obliged to claim proportionately

Answer 50

The insured

Question 51

Formula to calculate claim subject to contribution

Answer 51

Sum insured by ind insurer ÷ TSI × loss = insurers liab

Question 52

The condition of average can only apply to

Answer 52

Property insurances that have a Sum Insured

Question 53

Clause effectively recognises that the valuation of certain property can vary during the policy period

Answer 53

Average relief clause or special condition of average