Chapter 10: Claims Handling Flashcards
How does underwriting interface with claims?
Through wording, claims data, and commercial pressures on claims
How does outwards reinsurance interface with claims?
Claims must know which clauses the reinsurance uses, and keep data up tp date for renewals etc
How do complaints interface with claims?
Clear exchange of knowledge, and advise on regulatory information to claims
How does management information interface with claims?
Gets claims input on any system changes, and reviews reports with claims to make sure dta is accurately reported
How does legal interface with claims?
When claims go to litigation, and on wordings
How does compliance interface with claims?
Ensuring all claims handlers are trained and authorised, and managers are aware of regulatory requirements
How does marketing interface with claims?
Clear up any opacities in marketing, and marketing should use claims as a tool
How does senior management interface with claims?
Senior management should hear about large claims
How does finance interface with claims?
Payment and cash flow issues
What is ‘first notification’?
When the broker first hears about the claim, and works out which insurers need to be advised
How are claims managed in IUA Company Market (non-marine)?
All the individual insurers must agree
How are claims managed in IUA Company Market (marine)?
Advice can be agreed by lead company makret underwriter, whilst settlements can be agreed bu the first two companies, unless it is marine business in Lloyds, where only one company can bind
What is the Lloyds Claims Lead Arrangements?
Arrangements that explain how claims are piad
Under Lloyds, when is a financial claim complex?
If it is more than 1m for third party business, 2m for first party business, pr 5m for XoL re
Under Lloyds, when is a non-financial claim complex?
If there is a claim for extracontractual damages, a complaint of non-compliance, or dispute resolution proceedings are ongoing
What is Single Claims Agreement Party?
A clause that says only one party can do claism agreement- eligible if claim is under £250,000
What type of experts can be engaged for claims handling?
Lawyers, loss adjustors, loss assessors, surveyors, third party administartors, accountants, investigators, specialst experts, average adjustors in marine claims, or subrogation specialists
In what types of insurance is first notifcation of loss mot to a broker, but experts?
Professional indemnity- lawyer
Cargo- surveyor
What happens if an insurer declares organisational level conflict?
They have to give up agreement party role, and another insurer has to take over doing this
Define ‘electronic claims file’
How a broker can load and submit a file anywhere in the world with an internet connection
What does the Enterprise Act 2016 allow insureds to do?
To claim if their payment has not been settled ina reasonable amount of time
What is a loss fund?
Money given by insurers to coverholders with claims authority, to allow them to pay out claims properly
Define ‘indemnity’
Returning the insured to the position they were in before the loss happened- not benefitting them
Define ‘contribution’
Two insurers covering the same subject matter against the same risk
