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Cert CII- IF4 > Chapter 4 -Claims handling procedures and related claims services > Flashcards

Chapter 4 -Claims handling procedures and related claims services Flashcards

1
Q

should an insured still notify insurers of a private motor claim even if they dont have comprehensive cover?

A

yes, however the insurer will take no further action in reespect of any damage to the policyholders own property because they have no cover for this

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2
Q

If a third party is liable an the insured has full motor comprehensive cover, what condition will insurers utilise to recover costs?

A. Litigation

B.Subrogation

A

B.subrogation

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3
Q

What policies does health claims regard?

A

A. Personal accident
B. Sickness

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4
Q

In respect to Health claims specify what an insured shouldprovide evidence for the following scenarios:

A.Death of accident or sickness

B. Suffered the loss of a limb or limbs

C. Temp or permanately disables

A

A. Coroner’s inquest and post-mortem examination

B. Sufficient proof must be provided

C. Medical certificate and be in the care of a registered doctor.

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5
Q

What are home contents defined as and what indeminty will usually be paid in the event of a claim?

A

Any item you or your family are responsible for, including personal belongings.

A ‘new for old’ basis

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6
Q

In respect to Household buildings claims how is the repairing sum normally calculated?

A. Cost of bulding

B.Cost of reinstatement + Betterment

C.Cost of reinstatement - Betterment

D.Cost of building - Cost of reinstatement

E.Cost of building - Betterment - Cost of reinstatement

A

C.Cost of reinstatement - Betterment

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7
Q

Please Maytch and specify the processing for the different sections of travel insurance claims?

A. Personal accident or sickeness benefits

B.Travel Interruption or delay

C.Medical and associated expenses

D.Baggage, personal effect and money

1. Insurer will usually request proof of piurchase for items being claimed for, together with confirmation that the loss has been reported to the necessary authorities.

2.Usually authorised prior to treatment so that costs can be controlled and emergency medical expenses claimed after treatement are scrutinised prior to payement.

3.Considerations that apply to health claims generally apply

4.Insurers generally make its own enquiries with the travel authorities and ask the insured for proof

A

A.. Personal accident or sickeness benefits
3.Considerations that apply to health claims generally apply

B.Travel Interruption or delay
4.Insurers generally make its own enquiries with the travel authorities and ask the insured for proof

C.Medical and associated expenses
2.Usually authorised prior to treatment so that costs can be controlled and emergency medical expenses claimed after treatement are scrutinised prior to payement.

D.Baggage, personal effect and money
1.Insurer will usually request proof of piurchase for items being claimed for, together with confirmation that the loss has been reported to the necessary authorities.

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8
Q

What is the reason for Extended warranties policies not subject to fraudalent claims as frequent as other classes such as household and motor?

A

Because the indemnity is usually repaired or replaced therefore as there is no cash incentive to be gained fraud is less frequent

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9
Q

What will a typical pet insurance policy cover? (select all that apply)

  1. Cover to friends pets that where under your supervision
  2. Costs for third party property damaged by your pet
  3. vet fees
  4. theft of a pet
  5. attacking another dog
  6. euthenasia fees
A
  1. vet fees
  2. theft of a pet
  3. euthenasia fees
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10
Q

In respect to a property claim what does the insured have a duty to do? (select all that apply)

A. Notify the insurer immediately

B. Mitigate their losses

C. Deliver to the insurer full information about the property losts

D.Provide proof of loss

A

A. Notify the insurer immediately

B. Mitigate their losses

C. Deliver to the insurer full information about the property losts

D.Provide proof of loss

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11
Q

In respect to a ‘All risks’ property claim what will an insurer normally do for larger claims?

A

Appoint a loss adjuster who will ensure the claim is valid and negiotate settlement on behalf of the insurer.

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12
Q

In respect to ‘theft’ property claims what will the insurer require the insured to do?

A

Notify the appropriate authorities and a copy of the police report.

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13
Q

In respect to ‘glass claims’ whom does an insurer normally have?

A

Approved repairers. Due to claims rarely being overstated the fee’s for repaires will be passed to the insured with a deductible

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14
Q

in respect to ‘Money’ claims Once an insurer has completed standard investigations along with proof of loss what will an insurer request?

A
  1. Proof that the money,cheques or stamps where on the premises
  2. details of the occurence
  3. confirmation the matter has been reported to authorities
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15
Q

Due to insurers able to asses the potential liabiltity before the claim comences for legal expsenses insurance, what would be the two steps insurers may take in this period?

A

1.Appoint its own solicitor
2.Co-operating with the insured in attempting to reach a settlement before the court action starts

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16
Q

What does business interruption cover?

A

Insured’s loss of profits following damage to their property caused by the action of an insured peril. (NOTE: the property must be insured before a business interruption cover)

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17
Q

what may an insurer ask the insured in relation to a business interruption claim? (select all that apply)

  1. Can you sell the premises?
  2. is there part of the property you can still use?
  3. have they got alternative property?
  4. How soon can they get up and running?
  5. Will your suppliers still pay you?
  6. Is there a detailed disaster property plan?
  7. Who was at fault?
A
  1. have they got alternative property?
  2. How soon can they get up and running?
  3. Is there a detailed disaster property plan?
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18
Q

what may an insurer ask the insured in relation to a business interruption claim? (select all that apply)

  1. Can you sell the premises?
  2. is there part of the property you can still use?
  3. have they got alternative property?
  4. How soon can they get up and running?
  5. Will your suppliers still pay you?
  6. Is there a detailed disaster property plan?
  7. Who was at fault?
A
  1. have they got alternative property?
  2. How soon can they get up and running?
  3. Is there a detailed disaster property plan?
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19
Q

In respect to business interruption claims what are the usual indemnity periods?

A

(12,24 and 36 months)

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20
Q

What is creditor insurance?

A

Covers a policyholder in the event that they are unable to repay a loan due to their death, disability or losing their job.

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21
Q

In respect to creditor insurance what will an insurer usually require in an event of a claim?

A
  1. Proof that the insured isnt working
  2. Evidence of the payments that the insured needs to make
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22
Q

What act made Employers’ liability insurance compulsory in the UK?

A

Employers’ Liability compulsory Insurance Act 1969

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23
Q

what policy is Employer’s liability normally combined with?

A

Public liability

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24
Q

Is a professional indemnity policy usually written on a claims-made basis or Date of loss basis?

A

Claims-made basis

25
Q

Is a Employers and Public Liability policy usually written on a claims-made basis or Date of loss basis?

A

Date of loss basis

26
Q

MOJ/Claims portal incorporates employers’s and public liability claims up to what value and after what accident date?

A

Upto £25,000.00 and on or after 31 July 2013.

27
Q

Under MOJ/Claims portal employers’s and public liability claims what is the max amount recoverable for legal costs by successful claimant solicitors:

  1. Claims upto £10,000
  2. Claim between £10,000 - £25,000
A
  1. £900 plus VAT
  2. £1,600.00 plus VAT

These only apply if the claim does not leave the process nor proceed to litigation

28
Q

For third party property damage what will the insurer look at to reach a decision on liability?

A
  1. Written report of the negligence alleged against the insured
  2. Evidence to support the amount of the claim
  3. if required, an inspection of the damaged property
29
Q

Under a commercial vehiles policy why might the insurer not use their authorised repairer?

A

Many commercial vechiles require specialist repair.

30
Q

What of the following is true about a legal helpine?

  1. Open 6am-9pm everyday, Free to the user
  2. Open 6am-9pm everyday, Pro rata for calls
  3. Open 24hrs everyday, Free to the user
  4. Open 24rs everyday , Pro rata for calls
A
  1. Open 24hrs everyday, Free to the user
31
Q

What two main services does Legal helplines offer?

A
  1. Advice and assistance in respect of potential claims
  2. Advice only (Usually legal advice)
32
Q

Is the following statement true or false?

Legal helplines often act as the FNOL stage for claims under legal expenses insurance policies.

A

True

33
Q

What are suppliers/repaires’s insurer’s work with at a discounted rate known as?

A

Approved or Authorised repairers

34
Q

What are the main benefits of using approved repairers? (select all that apply)

  1. Convenience

2.Cost

3.Competence

4.Relationships

5.Control

A
  1. Convenience

2.Cost

3.Competence

35
Q

Why dont Insurers need to attend an authorised repairers premises to ‘inspect’ each vechile?

A

Because the repairer can email the photograph/video of the damage to the insurer

36
Q

What is an uninsured loss?

A

Losses that an insured may suffer that are not direclty covered by a policy of insurance relevant to an insured event.

A good example is if a claim is under the deductible.

37
Q

What does legal expenses insurance provide cover for?

A

Provides an instuction of solicitors or claim companies to recover unisnured losses.

38
Q

What does the term ‘before the event’ (BTE) cover mean?

A

The cover provided by legal expenses policy which is appropriate for any legal costs associated with an incident likley to give rise to a claim.

39
Q

Organisations such as accident management companies and solictors offer ‘Conditional fee agreement’ (CFA) what is this?

A

Where they offer a service to recover uninsured losses and they are successful they are entilted to a percentage of the recovery. These are on a ‘no win, no fee’ basis.

40
Q

What is ‘after the event’ (ATE) legal expenses cover?

A

Effectively underwrites the possibility that the court action will be unsuccesful. Premium is paid to insurer and policy guarentees payment of the legal costs associated with the prosecution of the claim. This can sit alongside with a CFA.

41
Q

What does ‘ Qualified one way costs shifting’ prohibit?

A

Recovery of costs from the losing claimant, apart from in limited circumstances.

42
Q

Organisations that arrange Conditional fee agreements (CFA’s) and Damages based agreement(DBA’s) are entilted to a percentage capped at?

A

25% of general damages

43
Q

In what 3 ways can Financial Risk control be achieved through?

A
  1. Risk retention
  2. Risk transfer
  3. A combination of both
44
Q

in what 2 ways can Physical Risk control be achieved through?

A
  1. Risk Avoidance
    2.Risk reduction
45
Q

What are the 3 options a Liability Insurer can offer REHABILITATION?

A
  1. Medical

2.Vocational

  1. Qualitative
46
Q

What is the aim of the Civil Procedure Rule? select all that apply

1.Reduce Cost, delay and complexity in the handling of Public Liability claims and to prevent litigation where possible

2.Reduce Cost, delay and complexity in the handling of Third Party Liability claims and to prevent litigation where possible

3.Reduce Cost, delay and complexity in the handling of personal injury claims and to prevent litigation where possible

4.Reduce Cost, delay and complexity in the handling of Legal Liability claims and to prevent litigation where possible

A

3.Reduce Cost, delay and complexity in the handling of personal injury claims and to prevent litigation where possible

47
Q

What are the 3 ‘tracks’ in the courts? (select all that apply)

  1. Large Claims
  2. Complex Claims

3.Small Claims

  1. Fast track

5.Multi-track

6.Single-use track

7.Slow track

A

3.Small Claims

  1. Fast track

5.Multi-track

48
Q

Does the 8 re-action protocols (PAP) come along with strict timetables and penalties for non-compliance?

A

True

49
Q

What does the Personal Injury (PI) pre-action protocol set out?

A

Rules that parties must adhere in order to present and negiotate the claim, prior to issuing court precedings.

50
Q

Alongside CLA 2008 there was a second legislation that increase the Small claims track for RTA claims to £5000. This applies to drivers and passengers in motor vechiles but specifically excludes whom?

A
  1. Vulnerable Road users
  2. Children and protected parties
    3.Claims where the defendant is not a UK resident or driving a UK registered vehcile

All the above’s claim follow the Low Value Pre Action Protocol

51
Q

What does the new OFFICIAL INJURY CLAIM (OIC) enable litigants to do?

A

Enables litigant in person to bring their clam with or without legal representation.

NOTE: claims cannot leave this process, unlike the Low Value Pre Action protocol

52
Q

Any claim that is re-valued over £5000 leaves the OIC and enter’s what Portal?

A

MOJ portal

53
Q

In respect to OIC claims, once liability has been established the compensator and claimant have upto how many negiotations to agree quantum?

A

3 negiotations, with the claimant having the right to issue small claim proceedings if they dont accept offers made

54
Q

The following RTA claims are managed via an electronic portal (known as CLAIMS PORTAL or MOJ PORTAL) however at what claim value’s?

1.RTA Personal Injury claims

2.RTA claims for vunerable users and minors

3.Employer Liability (EL) or Public Liability (PL)

A
  1. Claims Valued between £5K - £25K

2.Claims Valued between £1K - £25K

3.Claims Valued between £1K - £25K

55
Q

Under the MOJ PORTAL or CLAIMS PORTAl what are the deadlines for the agreement of liability for:

  1. RTA
  2. PL

3.EL

  1. what is the set negiotation period
A
  1. RTA - 15 days
  2. PL - 40 days

3.EL - 30 days

  1. what is the set negiotation period - 35 days
56
Q

what are the limits for the following to use the small claims track ?

  1. Property damage

2.RTA Claims

3.Liability claims

A
  1. Property damage - £10k

2.RTA Claims - £5k

3.Liability claims - £1.5k

57
Q

what is the starting point for commencing proceeedings in the small claims track?

A

N1 Money claim, whihc is submitted to the court with the court fee

58
Q

what is the starting point for commencing proceeedings in the small claims track?

A

N1 Money claim, whihc is submitted to the court with the court fee

Cert CII- IF4 (7 decks)

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