Chapter 10 - Claims handling Flashcards
What is the brokers role in the claims process?
Provide updated information to insurers, as provided by the client and any experts appointed
If required, negotiate on behalf of their client
Receive any claims funds for onward transmission to their client
how do the basis or rules for claims differ between markets?
Lloyd’s market - lloyd’s Claims Lead Arrangements
IUA company market (marine and aviation) - IUA claims handling agreements
IUA Company market (non-marine) - no binding possible - each insurer agrees for its own share
What are the IUA (marine + aviation) requirements for settlements?
Marine business (not excess of loss) - if Lloyd’s involvement only one company can bind the rest of the company market, no Lloyd’s agreement first to companies are required to agree
Aviation (not excess of loss) - direct business, first two companies are required to agree, fac reinsurance only lead company
Excess of loss reinsurance - the first two companies must agree
What are the two categories claims fall under in Lloyd’s?
Financial and non-financial, they can be standard or complex
What is the single claims agreement party (SCAP)?
A project promoted by the broking community who wanted to try and streamline the handling and agreement of smaller, less complex claims on business placed within the LM
What is the technical processing service?
Includes entering of data, sending out overnight messages to Lloyd’s insurers and moving funds from syndicates to brokers
what is a terms of engagement?
Documents that some insurers issue to help the expert understand what is required of them
what are some examples of insurance which requires insurers to name an expert in the event of a loss?
PI - insurers nominate a lawyer to be the point of contact for the insured to notify a claim
Cargo - insurers anticipate that the insured will immediately notify a surveyor local to them at the time and place of loss, to review and suggest potential remedial action for damaged cargo
What is the Electronic Claims File (ECF) and what are the two components?
Is a way in which the broker is able to load and submit data and documents to insurers anywhere with an internet connection.
Two components: data messaging system/database called CLASS; document repository
what is an organisational and individual conflict?
Organisational - the insurer as a whole decides that it cannot be an agreement party on the claim so the role is passed on to the next insurer on the list
Individual - deals with conflict internally, files are clearly marked so brokers know who to see within the organisation
what are some of the key fraud triggers?
Excessively documented claims file
pressure to settle
reluctance to answer questions
stories that do not add up
what is the Insurance: Conduct if Business sourcebook (ICOBS)?
Contained within the FCA handbook and includes an entire chapter dedicated to requirements for claims handling
what are the forms of financial sanctions?
Prohibiting the transfer of funds to a sanctioned country
Freezing the assets of a company or individual
Freezing the assets of a whole government as well as the companies and residents of country concerned
what is the financial ombudsman service (FOS)?
A free independent and impartial service that deals with unresolved disputes, membership is compulsory for all authorised firms
when can the complainant refer their complaint to the FOS within the earliest of ?
six months of the date on the firm’s letter advising the claimant of its final decision regarding the complaint
six years after the event complained about#
3 years after the complainant knew, or should have known, that they had cause for complaint
