chapter 10 - B Flashcards
What is the role of the broker in the claims process?
The broker is the first point of contact with the insured and gathers information about the loss, determining which insurers need to be advised.
This includes reviewing insurance contracts and deciding on the method of presentation for the claim.
What is meant by ‘first advice’ in the claims process?
‘First advice’ refers to the initial notification of a claim by the insured to the broker.
This stage is critical for gathering information about the loss.
What ongoing responsibilities does the broker have in the claims process?
The broker’s ongoing responsibilities include:
* Providing updated information to insurers
* Negotiating on behalf of their client
* Receiving claims funds for onward transmission to their client.
These responsibilities ensure effective communication and management of the claims process.
What are the two main claims handling agreements in the London Market?
The two main claims handling agreements are:
* Lloyd’s Market claims agreements
* International Underwriting Association of London (IUA) agreements.
These agreements determine how claims decisions are made and who binds the rest of the market.
How do claims agreements differ between Lloyd’s and IUA Company Markets?
In Lloyd’s, claims can be decided by a single leader, while the IUA Company Market requires agreement from all individual insurers.
This distinction affects how claims are processed based on the type of market.
What is the significance of the Lloyd’s Claims Lead Arrangements?
The Lloyd’s Claims Lead Arrangements outline the basic rules for claims agreements and exceptions for certain classes of business.
This document is vital for understanding how claims are managed within the Lloyd’s Market.
What defines a complex claim in the Lloyd’s Market?
A claim is complex if:
* The amount claimed exceeds certain financial thresholds
* There are allegations of non-compliance with regulatory requirements
* There are active or potential dispute resolution proceedings.
Financial thresholds include over £1m for third-party business.
What is the purpose of the Single Claims Agreement Party (SCAP)?
SCAP aims to streamline the handling and agreement of smaller, less complex claims within the London Market.
It allows for quicker processing of claims under certain financial limits.
What types of experts might be used in the claims process?
The types of experts include:
* Lawyers
* Loss adjusters
* Loss assessors
* Surveyors
* Third-party administrators
* Accountants
* Investigators
* Specialist experts
* Average adjusters
* Translators
* Subrogation/recovery specialists.
Each expert serves a specific role in evaluating and managing claims.
What is dynamic triage in the context of claims handling?
Dynamic triage refers to the process where claims can move between categories of complexity during their lifecycle based on new information.
This ensures that claims are managed efficiently according to their current status.
True or False: The broker is the only party involved in the claims process.
False.
Multiple parties, including insurers and experts, are involved in the claims process.
Fill in the blank: The broker needs to obtain the agreement of all individual insurers on a risk that are placed within the _______.
Company Market.
This is necessary when no single leader is designated.
What responsibilities do leaders have under the Lloyd’s Claims Lead Arrangements?
Leaders are responsible for:
* Ensuring followers are kept informed
* Applying watch list codes
* Sending structured communications
* Calling market meetings.
These responsibilities ensure transparency and effective communication in the claims process.
