Chapter 1

Question 1

What is the claims department seen as in an insurance company?

Answer 1

Shop window

Question 2

In respect to claims when will an insurer be judged?

Answer 2

If a claim is not properly and fairly dealt with

Question 3

who contributes to the pool claims are paid from?

Answer 3

Policyholders

Question 4

when is a legally binding contact formed?

Answer 4

when someone takes out an insurance policy

Question 5

When an insured makes claim, what is the term used to show that it is a valid claim?

Answer 5

Onus of proof

Question 6

what are the two things an insured needs to prove to make a claim?

Answer 6

That an insured peril arose, amount of loss

Question 7

List 3 items that could prove the amount of a loss

Answer 7

Purchase receipt, repair account, valuation

Question 8

what type of claim willl the insured not need to prove the amount of the loss

Answer 8

Liability claim

Question 9

when does ‘onus of proof’ move to an insurer?

Answer 9

When the insurer refuses to pay a claim. (They must prove reasons to refusion)

Question 10

what are the duties(need to ensure) of an insurer in respect of a claim? (There is 8)

Answer 10

1. Cover was in force at DOL
2. Insured is the same as that named in the policy
3. Peril is covered
4. Insured has taken steps to mitigate
5. All conditions and warranties have been complied with.
   6.Duty of fair presentation/Duty to take care not to make a misrepresentation
   7.No excpetions apply
6. Value of loss is reasonable

Question 11

There is two types of conditions in a policy one is express what is the other?

Answer 11

express and implied

Question 12

what can happen if a condition precedent to liability or recovery is not met?

Answer 12

Insurers can avoid liabilty for a particular loss

Question 13

Why might a claim only be partially met?

Answer 13

sum insured(or limit of liabilty), Average clause(underinsurance), Excess or deductible

Question 14

Under the Consumer rights act 2015 when can a term of contract be assesed for unfairness?

Answer 14

when it is NOT: Transparent or prominent

Question 15

Under the Consumer rights act 2015 what is an ‘Average consumer’?

Answer 15

Someone who is ‘reasonably well informed, observant and circumspect’

Question 16

What happens if a contract term is deemed unfair?

Answer 16

it will not be binding (This applies to contract and notices such as renewals and customer promotions)

Question 17

List the implied duties of the insured (There is 6)

Answer 17

1.Act as though they are unisured
2.take reasonable steps to minimise loss,
3.advise appropriate authorites in event of a loss,
4.take all steps to prevent a loss spreading,
5.not hinder the insurer in claims investigsation,
6.assist the insurer when possible

Question 18

In a Policy there is normally 2 terms that gives out express duties for the insured. What are these 2 terms titled?

Answer 18

1.Claims procedure
2.action by the insured

Question 19

List the express duties of the insured

Answer 19

1.Notify the insurer promptly,
2.involve the emergency services if appropriate,
3.take steps to prevent further damage,
4.give proof and details of the loss within a certain timescale

Question 20

In respect to motor or liability claims what are the circumstances when notification of loss are forwared to insurer ASAP?

Answer 20

Fatal injury inquiries, coroner’s inquests, proceedings or prosecutions

Question 21

What is the usual way to report a FNOL?

Answer 21

Telephone process whereby the customer calls a hotline to report the claim to a dedicated claims team.

Question 22

What is used for more complex claims to gather initial claim information?

Answer 22

Claim form

Question 23

What is the benefit of online FNOL to the insurer?

Answer 23

Control over cost, requirement for call centre staff being available 24/7 diminishes.

Question 24

What is the benefit of online FNOL to the insured?

Answer 24

Immediate access to service, claims process is simplified, no interaction with claims staff or long waiting times, claims are settled more quickly, quality of repair and replacement work.

Question 25

When will a claim form normally be issued?

Answer 25

On conclusion of the FNOL, Directly by the broker that sold the policy

Question 26

What are the purposes of a claim form? (There is 5)

Answer 26

1. Establish whether the insured is entiled to indemnity
   2.provide sufficient information to permit the insurer to begin processing the claim
   3.enable insurer to assess severity of claim
   4.Enable insurer to assess if there is potential third party claim
   5.Enable the insurer to consider recovery rights

Question 27

What is normally found in a property claim notification?

Answer 27

Description of property damaged, date, cause, circumstances, amount of loss, situation and occupancy of the premises, capacity in which the insured is claiming, any other person has interest, whether there is any other insurance in force.

Question 28

What is normally found in a motor accident notification?

Answer 28

Details of the insured, vechile involved in accident and its use, specific detail of accident, sketch plan of the accident scene, deatails of any witnesses

Question 29

Once a claim form has been received why might the claims department check its underwriting records?

Answer 29

To ensure the policy is in force, that the peril has caused the loss or damage is covered in the terms of the policy

Question 30

Why will an insurer compare the answeres from a claim form to a proposal form?

Answer 30

To ensure that there has not been a breach of the duty of fair presentation(commerical)/ Duty not to make a misrepresenation (Consumer)

Question 31

Where was ‘proximate cause’ defined in?

Answer 31

Pawsey v. Scottish Union and National (1907)

Question 32

What is a proximate cause?

Answer 32

It is the dominant cause and there is a direct link between it and the resulting loss

Question 33

Name the 3 types of perils

Answer 33

Insured perils, Excepted or excluded perils, uninsured or unnamed perils

Question 34

Please classify on what each of the following perils are:

EXP:

Insured perils - Those named in the policy as covered

Excepted or excluded perils -

Uninsured or Unamed perils -

Answer 34

Insured perils - Those named in the policy as covered

Excepted or excluded perils - Those named as specifically not covered

Uninsured or Unamed perils - Those perils not referrred to in the policy and therefore not insured