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M94 > Chapter 7 > Flashcards

Chapter 7 Flashcards

1
Q

Corporate Claims Philosophy

A

A vision and set of values aligned with overall business objectives, serving as a mental picture of desired outcomes

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2
Q

Mission or Vision Statement

A

Mission - reflects the organisation’s core purpose and values

Vision - reflects an aspiration or ideal outcome

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3
Q

Importance of Claims Philosophy

A
  • enhances marketing and customer retention
  • establishes a unified approach to claims handling
  • provides clear service expectations for staff and customers
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4
Q

Origin of Claims Philosophy

A

Originated from the Association of British Insurers (ABI) and was formalised by Lloyd’s

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5
Q

Benefits of ISO 9001

A
  • promotes consistency in service levels
  • provides a structured quality management system
  • enhances customer retention and marketing strategies
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6
Q

What is ISO 9001

A

An internationally recognised standard for quality management

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7
Q

ISO 9001 2015

A
  • high level structure for standardised management systems
  • greater focus on leadership engagement
  • structured risk management approach
  • simplified language and common structure
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8
Q

ICOBS Chapter 8

A

8.1 - handle claims promptly and fairly; give reasonable guidance and not unreasonably reject claims

8.1.2 - qualifying misrepresentation

8.2.6 - insurers must provide a reasoned offer or reply within three months of a claim

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9
Q

CUE Claims

A
  • motor claims (excluding windscreens)
  • household
  • travel
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10
Q

What is CACHE in relation to CUE?

A

(CRIF application for claims history exchange) is a supplier offering access to CUE

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11
Q

Credit Industry Fraud Avoidance System (CIFAS)

A

A UK based non-profit fraud prevention association

A CIFAS warning is placed against the address used, prompting extra checks for future applications

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12
Q

Insurance Fraud Enforcement Department (IFED)

A
  • a police unit focused on fighting insurance fraud
  • costs £8.7million, paid my insurers
  • started in Jan 2012
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13
Q

Insurance Fraud Register (IFR)

A
  • a database of proven insurance fraudsters
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14
Q

Insurance Fraud Types

A
  • fake no-claims bonuses
  • exaggerated claims
  • “fronting”
  • fake theft claims
  • staged car crashes
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15
Q

National Plant and Equipment Register (TER)

A

A database of stolen plant and equipment (machinery)

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16
Q

Credit Reports

A

Reports used to check financial history and creditworthiness to help assess credit risk

Individuals - credit checks, debts
Businesses - company accounts, credit scores and legal status

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17
Q

Claims Support Software

A

Helps to calculate low to mid-value injury claims
- Colossus by DXC Technology

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18
Q

Voice Recognition Software

A

A tool that detects changes in vocal tone to identify potential lies

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19
Q

Cognitive Interviewing and Conversational Management

A

Cognitive Interview: developed by Fischer and Geiselman (1992)
- ensures cooperation and accurate recall from witnesses

Conversational Management: developed by Dr Eric Shepherd (1991)
- encourage uncooperative subjects to share details

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20
Q

National Hunter

A
  • detects application fraud in finance and insurance
  • verifies application accuracy
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21
Q

Big Data

A
  • large varied data sources such as social media, satellite, CCTV and medical reports
  • reduces fraud and accidents
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22
Q

Data Protection Legislation

A

The UK General Data Protection Regulation (UK GDPR) and the Data Protection Act 2018 (DPA)

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23
Q

Sensitive Personal Data

A
  • race/ethnic origin
  • political opinions
  • religious beliefs
  • trade union membership
  • genetic data
  • biometrics (for ID purposes)
  • health data
  • sexual orientation
24
Q

Data Protection Principles

A
  • lawfulness, fairness and transparency
  • purpose limitation
  • data minimisation
  • accuracy
  • storage limitation
  • integrity and confidentiality
  • accountability
25
Lawful Processing for Personal Data
- consent - contract - legal obligation - vital interests - public task - legitimate interests
26
FinTech and InsureTech
Fintech - refers to new financial products, services and processes that incorporate intensive use of technologies InsureTech - application of technological innovations in the insurance sector
27
AI in Motor Insurance
Applications: claims registration, damage assessment, repair authorisation, fraud detection and liability evaluation Challenges: lacks emotional intelligence and creativity
28
Fraud Act 2006
- making false/misleading representation - failing to disclose information legally required - abusing a position of trust
29
Bribery Act 2010
- paying or receiving bribes - bribing foreign officials - failure of organisations to prevent bribery
30
Criminal Justice and Courts Act 2015
Section 57: allows dismissal of personal injury claims if they are “fundamentally dishonest” Section 58: prohibits inducements for pursuing personal injury claims
31
Civil Liability Act 2018
- fixed compensation for whiplash claims - new tariff for pain, suffering and loss of amenity for injuries lasting 0-24 months - new requirements for medical evidence in whiplash claims
32
Motor Insurance Fraud
- induced accident - staged accident - contrived accident - application fraud - ghost policies
33
Total Loss Claims
actual total loss: vehicle is destroyed or unrepairable constructive total loss: repair costs exceed the vehicle value Category A: Scrap Only Category B: Break for Parts Category S: Repairable Structural Category N: Repairable Non-Structural
34
Fire and Theft Claims Investigation
- a police report or fire brigade assessment is needed for validation - insurance may be denied if it is suspected that the vehicle was intentionally damaged
35
Multi-Vehicle Accidents and Liability
Insurers encourage policyholders to claim under their own policy and settle liability between insurers
36
Vulnerable Road Users
- pedestrians - cyclists - children - escooters
37
UK Stance on E-Scooters
- privately owned scooters are illegal on public roads - rental escooters can be used on public roads
38
Penalties for using E-Scooters illegally on Public Roads
- up to 6 penalty points and a fine up to £300
39
Contributory Negligence
- when the claimant is partly at fault for their own injury - passengers not wearing seatbelts can be found contributorily negligent - cyclists not wearing helmets may face this
40
Admission of Liability
- insured individuals must not admit liability without insurer consent - solicitors must act according to insurer instructions - liability should not be denied until all evidence is reviewed
41
Without Prejudice
- allows free negotiation without the risk of statements being used in court - communications marked “without prejudice” cannot be admitted as evidence
42
Litigation Process
Claim Form (Part 7) - initiates proceedings in county or high court Part 20 - allows counterclaims, TP claims and co-defendant contributions Part 36 - parties can make offers to settle and costs are affected by these offers
43
Damages Claim Portal (DCP)
- legal representatives must use the DCP for certain claims - simplifies the process for personal injury claims
44
Fixed Costs for RTA Claims
Claims between £1k and £10k - stage 1 costs £200, stage 2 costs £300 Claims between £10k and £25k - stage 2 costs £200, stage 2 costs £600
45
Legal Aid, Sentencing and Punishment of Offenders Act 2012
Removed the recoverability of success fees from the losing party
46
Special Damages
- loss of earnings - medical expenses - out of pocket expenses - hire of an alternative vehicle - loss of services
47
General Damages
- pain, suffering and loss of amenity - future loss of earnings - smith v. Manchester award - loss of congenial employment - future loss of capacity - pension loss and care costs
48
Fatal Injury Legal
Law Reform (Miscellaneous Provisions) Act 1934 and Fatal Accidents Act 1976
49
Interest for Damages
General Rule: awarded at the court’s discretion, as per s.35A of the Supreme Court act 1981
50
Provisional Damages
Awarded when a claimants condition may deteriorate or develop a new serious condition, allowing for future claims if the situation worsens
51
Structured Settlements
- involves a sum paid to the claimant with further sums over a period of years - generally free of tax - used for claims above £200,000 to ensure inflation proofing
52
Rehabilitation
Vocational : Employment Medical : Treatment Qualitative : Enjoyment
53
Heil V. Rankin (2000)
- resulted in a general increase in personal injury awards - led to the revision of awards for injuries over £10,000 - courts use Kemp and Kemp for quantum of damages
54
Ogden Tables
assess life expectancy and future losses in personal injury and fatal accident cases
55
Personal Injury Discount Rates
- initially 2.5% (2001) - reduced to -0.75% (March 2017) - increased to -0.25% (August 2019)

M94 (8 decks)

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