Chapter 8 - Making a claim Flashcards
Doctrine of privity of contract - when may a third party enforce a contractual term
- The contract provides that they may do so
- The contract purports to confer a benefit on the third party
Does a loss need to be fortuitous
Meaning happen by chance
Yes
Summary of nature of perils
Loss caused by Insured peril
Insured peril is prox cause
Loss is covered
Loss caused by excepted (excluded) peril
Excepted peril is prox cause
Loss is not covered
Loss caused by unnamed peril
Insured peril is prox cause
Loss is covered
Concurrent perils (2 causing loss)
Independent - each would cause the loss on their own - covered if can prove loss is from insured peril
Interdependent - neither would cause loss on their own
- Insured peril plus excluded peril = exclusion prevails and loss not covered
- Insured peril and unnamed peril = insured prevails and loss is covered
Fraudulent claims classification
Falsification of loss = no loss at all
Deliberate loss
Exaggerating loss
Lying about circumstances to improve chances - known as ‘fraudulent device’
Requirements to prove fraud - civil vs criminal
Criminal = pros to prove beyond reasonable doubt
Civil = pros to prove on the balance of probabilities
Under English law, and element of statutory control over the wording of consumer insurance policies is imposed by the
Consumer Rights Act 2015
What legal remedies, are available to an insured who has suffered a loss as a result of an insurer’s unreasonably late payment of a claim?
Contractual damages
Interest on any sums due under the policy
With which type of insurance would an insurer NOT be able to decline a legitimate claim on the basis that it was notified outside a stipulated period?
Employers’ liability insurance.
What rights, if any, does an equitable assignee have in relation to an insurance contract?
They may benefit from a claim made with the assignor.
A policyholder has a fire insurance policy which excludes storm and other perils. A fire broke out due to faulty machinery overheating. At the same time as the fire, a violent storm blew the roof off the buildings and caused a power cut so that the fire alarm did NOT operate which led to a more serious fire than would have occurred otherwise. For what damage, if any, would the fire insurers be liable?
The fire damage only
A policy condition requiring the policyholder to give notice of a loss and also any incident or event which may give rise to a claim, is most relevant in an insurance policy covering
professional liabilities
Joe has been injured in a motor accident. Under section 151 of the Road Traffic Act 1988, he has the right to make a direct claim against the insurer of the negligent driver, Sally, if he has an unsatisfied court judgement against Sally. True?
Yes
If an insurance claim is disputed and causation is an issue, what approach will a court take when looking to identify the proximate cause of the loss?
It will rely on the common understanding of causation by a normal person
What statute permits the third party victim of a motor accident to make a direct claim against the motor insurer of the negligent driver who caused the accident?
The Road Traffic Act 1988
