Chapter 10: Claims Handling Flashcards
Claims and other departments: UWs
- Report problematic wordings in intepretation
- Advise on clarity of wordings
- Provide claims data for risk renewal
- Liaise if claim is outside scope of coverage
- Discuss commercial pressures
Claims and other departments: Outward RE
- Need to know which RE have claims control or co-op clauses
- Provide adequate data
- Keeps claim data up to date
Claims and other departments: Complaints
- Provide clear claim handling info to enable handlers to deal with issues properly
- Complaints should provide advice on regulatory information to Claims and UWs
Claims and other departments: MI
- Provide input on system designs
- Review reports together to ensure data reported properly
Claims and other departments: Legal
- Outsourcing claims
- Liaise if claims go into litigation
- Legal advise on any issues of wordings
Claims and other departments: Compliance
- Claims handlers are well trained
- Manager should make sure staff are aware of regulations
Claims and other departments: Marketing
- Highlight any issues that have arisen where clients do not understand the product
- Claims is a publicity tool
Claims and other departments: Senior management
- report large claims
- report matters of wider importance
Claims and other departments: Finance
- ensure early warning given on large payments
- liaise in cases of high volumes of claims
Brokers role in claims process
- first point of contact for insured
- first party to find out about any claims (first advice)
Broker action upon First advice / First notification
- Broker must gather as much info as possible
- Review the MRC
- Work out which insurers are on risk
- Work out the best way to present the claim (electronically / paper file)
Brokers role on ongoing basis for claims
- Provide updated info to insurers provided by clients/experts
- Negotiate on behalf of their client
- Receive any claims funds and transmit onwards
Basis of rules for claims in Lloyd’s Market
Lloyd’s Claims Lead Arrangements (prev Lloyd’s Claims Scheme)
Basis of rules for claims in IUA Company Market (marine and aviation)
IUA Claims handling agreements
Basis of rules for claims in IUA Company Market (non-marine)
No binding possible - each insurer agrees for its own share
IUA Company Market (non-marine)
- members of that market are not prepared to agree to one leader making claims decisions
- broker needs to obtain agreement from all individual insurers on the risk
- Only exception is companies setting up an automatically bypassing claims agreement system if share is below limit
IUA Company market - Marine business (not excess of loss)
Lloyds involvement = one company can bind the rest of the Company market
No lloyds = first 2 companies must agree
IUA Company market - Aviation (not excess of loss)
If direct = first 2 companies must agree
if Fac RI = Lead only
IUA Company market - Excess of loss RI
Always the first 2 companies
Types of company grouping
Company can be identifed as being part of a non-marine or marine/aviation grouping by code allocation
Lloyds Claims Lead Arrangements
- Issued by Lloyd’s under byelaws
- Claims handling standard under Lloyd’s Market
- Basic rules concerning agreement parties required for claims
Complex claim
Claim with 2 leaders
Standard claim
1 leader
Financial criteria for a complex claim
Amount claimed
Net of deductibles/excess
If the Lloyd’s share on a single risk is:
- More than £1 million for 3rd party business
- More than £2 million for 1st party business
- More than £5 million for XoL RI
- if a risk code covers both 1st and 3rd business claims adjuster must decide the level to be