Chapter 10 - Claims Handling Flashcards
What is the “first advice” after a claim?
Contacting the broker
What is the broker’s role in first advice?
Gather as much information as they can about a loss and work out which insurers need to be advised
What is the broker’s ongoing role in the claims handling process?
- provide updated information to insurers, as provided by client and any experts appointed
- negotiate on bahelf of the client
- receive any claims funds for onwards transmission to client
What is the basis of rules in the IUA Company Market (non-marine) in claims?
Not prepared to agree to one leader making claims on behalf of others, so need to go to each insurer individually
What is the basis of rules in the IUA Company Market (marine and aviation) in claims?
- Marine non-XOL: if Lloyd’s involved, one Lloyd’s company can bind company market, if no Lloyd’s first two companies required to agree
- Aviation non-XOL: if direct, first two required to agree, if facultative reinsurance only lead company
- XOL reinsurnace: first two companies must agree always
How are claims handled within the Lloyd’s Market?
Lloyd’s Claims Scheme (Combined)
What are the two categories of claims in the Lloyd’s claim sheme?
- standard: under £250,000 (£500,000 for energy or property treaty), handled by leader only
- complex: over £250,000, (£500,000) handled by lead two syndicates
Outline the claims handling process
- when broker notified they find pout which insurers to notify
- broker submits infomration to agreement parties
- agreement parties consider information and respond to broker
- for Lloyd’s XCS enters claims data onto system and sent to syndicates
- if parties agree to funds, funds debited from insurrs accounts to broker
- process repeats as necessary
Why would an expert be the first to know about a loss?
Written into the policy as the notification point
What are the two types of conflict of interst?
- organistational conflict: insurer thinks organisation as a whole cannot be an agreement party on a claim
- individual conflict: insurer puts up Chinese Walls to manage conflict internally
Whta does the Enterprise Act 2016 imply?
Claims will be settled in a reasoable time is any insurance contract subject to English law
How is movement of money carried out?
- for company market, agreeing parties will automatically trigger money moving from their accounts
- Lloy’d market, XCS triggers movement of money
How are claims paid in binding authorities?
Insurers pay the coverholder a loss fund upfront to pay claims out of
What key points to London Market personel handling Californian claims need to be aware of?
- timelines for acknowledging recepit of claims
- timelines for updating insured should investigations be ongoing
- information insureds need to be given in the event a claim is denied
What forms can financial sanctions come in?
- prohibiting transfer of funds to a country
- freezing assets of a company or person
- freezing assets of a whole government
