Chapter 4 - Claims Handling Procedures And Related Services Flashcards
Process for private motor - cars and bike
Insured must report ALL accidents
Generally have to compete an accident report form
Repairs generally carried out by insurers own repairer
Third party may claim for damage to their vehicle/property
If customer has non comprehensive cover they must still report the accident but the insurer will take no further action for damage to their own vehicle as not covered for this. If insured has comprehensive cover and has a claim against a liable third party their insurer would surrogate on their behalf to recover.
Process for health claims - personal accident and sickness
Benefit policies- don’t indemnify
Insurers will check a valid contact is in force and will need supporting evidence including things like a death certificate, proof of lost limbs, medical certificates depending on circumstances.
HH process- buildings and contents
Contents split into durable contents (furniture, fridge, freezer) and consumer goods (things that wear out more quickly like curtains, towels and clothing).
Durable goods - settled on a new for old basis
Consumer goods - settled on new for old basis less wear and tear
Buildings - main settlement is repair/reinstatement at the time of loss less an allowance for betterment
Travel process
Process depends on which section of the policy the claim is covered.
Personal accident/sickness - considerations that apply to health claims generally apply
Travel interruption- insurer will make enquires with travel authorities
Medical expenses - usually authorised prior treatment to ensure costs are reasonable
Baggage - insurer will request proof of purchase for items and check loss has been reported to relevant people
Extended warranties process
Settlement will generally result in appliance being repaired or replaced.
As there is no cash incentive to be gained fraud is less common.
Pet process 🐕
Typical policy covers vets fees required followed accidental injury or illness as well as theft, boarding fees and even euthanasia 😫
For dogs policy can be extended to cover liability caused by the animal such as biting.
Property claims process (commercial) 🏠
Fire and special perils - insured must notify insurer immediately, mitigate loss, provide full details and proof. Insured would then establish 1) was policy in force 2) is claim valid 3) whether policy covers the loss. Settlement will generally be cash 💸
All risks claims- same as fire and special perils
Theft claims - insured must notify appropriate authorities and will generally liase with police 🚔
Glass claims - insurer will generally use an approved repairer as little financial incentive to overstate cost. Subject to XS to avoid small claims
Money claims - insurer will request proof of money etc was on the premises, details of circs and confirm matter was reported to authorises. Lots of scope here for customers to commit fraud so special investigators assist with enquires if needed💰
Legal expenses process (pecuniary insurance)
Different from other policies- insurers can access its potential liability before the claim starts.
Insured has no obligation to notify their insurance before legal action, insurers can take necessary steps such as appointing solicitors etc
Business interruption process (pecuniary)
Covers insured’s loss of profits after damage to their property caused by an insured peril.
There is aways a property damage condition with BI insurance (property itself must be insured before BI is taken out).
Q’s at proposal stage are based around what the customer would do in the event of the claim.
Indemnity period (usually 12, 24 or 36 months) is the max length of the claim.
Creditor insurance process (pecuniary)
Provides protection to the insured if they’re unable to pay a loan due to death, disability or unemployment.
Insurer would need proof the insured isn’t working/evidence of payments insured needs to make.
Employers liability process
Compulsory for UK employers, covers indemnity against injury or death in course of employment. Policy is usually combined with public liability and claims are common in industries such as mining (High risk).
Policies are written on a loss occurring basis.
Public liability process
Covers loss or damage to third party property and injury caused by negligence or breach of statutory duty.
Often combined with products liability - claims made basis
Public liability policies are written on a loss occurring basis
Professional indemnity process
Protect the insured against their legal liability to third parties for injury, loss or damage from their own negligence.
Policies are generally written on a CLAIMS MADE BASIS. Means claims against the insured must be made during the period of insurance.
What types of liability insurance are written on a claims made basis?
Professional indemnity
Product liability
Q’ are - when was the claim made, did cover exist at the time?
What types of liability policy are written on a loss occurring basis?
Employers liability
Public liability
Q’s are - when did the loss occur, did insurance cover exist at the time?
