Chapter 4 Flashcards
Uninsured losses
are those losses that an insured may suffer that are not directly covered by
a policy of insurance relevant to an insured event
What is an Accident Report Form (ARF)?
An ARF is a form the insured may need to complete after reporting an accident, either over the phone or online.
How are third-party claims for property damage handled in motor insurance?
The third party submits repair estimates; the insurer then assesses fault and may offer to handle the claim to control costs.
What is the role of an insurer in Business Interruption (BI) claims?
The insurer covers the insured’s loss of profits following property damage caused by an insured peril, participating to minimize loss during the claim.
What is a “claims-made” basis in professional indemnity insurance?
Coverage is triggered if a claim is made during the insurance period, regardless of when the event causing the claim occurred.
What are “Special Damages” in personal injury claims?
Special Damages cover quantifiable losses like medical expenses and future loss of earnings.
What is an “After the Event” (ATE) legal expenses cover?
ATE cover protects against the risk of losing a court case, covering legal costs if the claim is unsuccessful.
What are the four court tracks under the Civil Procedure Rules (CPR)?
Small Claims, Fast Track, Intermediate Track, and Multi-Track.
What are Pre-Action Protocols (PAP)?
PAPs are steps required before starting a court case, with strict timetables and penalties for non-compliance.
What is the purpose of fixed recoverable costs (FRC) introduced in October 2023?
FRC limits the legal costs that can be recovered in fast-track and intermediate-track cases, ensuring predictability in legal expenses.
What is the “MOJ/Claims Portal”?
It is an online system for handling employers’ and public liability claims up to £25,000, streamlining the process and capping legal costs.
What must a claimant’s solicitor do in a personal injury claim under the Civil Procedure Rules (CPR)?
The solicitor must send a Letter of Claim to the defendant’s insurer, which must be acknowledged within 21 days, followed by a 3-month investigation period.
What are “General Damages” in personal injury claims?
General Damages compensate for non-quantifiable losses like pain, suffering, and loss of amenity (PSLA).
What happens if an insurer suspects fraud in a money claim?
The insurer may enlist specialist investigators to ensure there is no fraud involved before settling the claim.
What is the significance of a property damage proviso in a Business Interruption (BI) policy?
It ensures that BI coverage is only available if the underlying property is insured, linking the BI claim to the property damage claim.
What is the “basis of contract” clause, and how has the Insurance Act 2015 impacted it?
The clause converted pre-contractual representations into warranties. The Insurance Act 2015 now prohibits this, protecting policyholders.
What does a “losses-occurring” basis mean in liability insurance?
Coverage is triggered by an event that causes a loss during the policy period, regardless of when the claim is made.
What must be proven in a liability claim involving property damage?
The insurer needs a report on the alleged negligence, evidence supporting the claim amount, and possibly an inspection of the damaged property.
What is “Qualified One-Way Costs Shifting” (QOCS)?
QOCS limits the circumstances in which a losing claimant must pay the defendant’s legal costs, providing protection in genuine claims.
What is the role of pre-action protocols (PAP) under the Civil Procedure Rules (CPR)?
PAPs encourage the early settlement of disputes through a structured process, with strict timetables and penalties for non-compliance.
What are “Special Damages” in personal injury claims?
Special Damages cover quantifiable losses such as medical expenses and future loss of earnings.
How does “after the event” (ATE) legal expenses cover work?
ATE insurance covers the legal costs if a court action is unsuccessful, with the premium paid to the insurer before the action starts.
What happens when a business interruption (BI) claim exceeds the indemnity period
The insurer’s liability ends when the indemnity period (e.g., 12, 24, or 36 months) ends, even if the business hasn’t fully recovered.
What must be confirmed in a money claim before the insurer proceeds?
Proof of loss, including evidence the money was on the premises, details of the occurrence, and confirmation it was reported to authorities.
What is the importance of the insurer’s “participation” in a Business Interruption (BI) claim?
The insurer may assist in minimizing the loss during the indemnity period, ensuring the business recovers efficiently.
What are the four court tracks under the Civil Procedure Rules (CPR)?
The four tracks are small claims, fast track, intermediate track, and multi-track.
How do professional indemnity insurance policies typically operate?
They are usually written on a “claims-made” basis, meaning coverage is triggered when a claim is made during the policy period, regardless of when the event occurred
What does the insurer evaluate in a liability claim involving a third party injury?
The insurer assesses the degree of negligence, the injury’s extent, the medical prognosis, and any related losses like loss of earnings or required care.
How did the Legal Aid, Sentencing and Punishment of Offenders Act 2012 (LASPO) affect ATE insurance premiums?
LASPO prohibited the recovery of ATE insurance premiums from the defendant, shifting the cost burden to the claimant.
Sophie has a private car policy and is involved in a motor accident for which she is at fault. She receives a letter from the third party’s solicitors making a claim for personal injury. Any offer to pay damages may take account of:
the degree of negligence by each party.
When a third party claimant has been injured and makes a claim, the liability insurer is likely to:
offer the third party rehabilitation that could include medical, vocational, or qualitative help.
If George has a comprehensive private car policy, what would NOT be regarded as an uninsured loss in the event of a non-fault accident?
Recovery cost of taking his vehicle to an approved repairer.
What type of policy is most often written on a claims-made basis?
Professional indemnity.
An insurer appoints approved repairers because they:
reduce costs and improve quality.
On what basis are public liability policies written?
On a losses-occurring basis.
What key change was introduced by the Access to Justice Act 1999?
It set out the rules on recoverable costs so far as legal costs are concerned.
For what period does an insurer’s helpline often operate?
24 hours a day
Which of these is NOT a pre-action protocol under the Civil Procedure Rules?
Question 34Answer
a. Defamation.
b. Property damage.
c. Personal injury.
d. Professional negligence.
b. property damage
