Chapter 9 Flashcards
When loss, damage or injury occurred who do the initial responsibilities fall on?
A) insurer
B) insured
B) insured
What do theft and malicious damage claims require notification to
A) insurers
B) police
B) police
Who does the onus of proof initially fall on
A) insured
B) insurer
A) insured
What two things must the insured prove for the onus of proof
That an insured peril arose
The amount of the loss
Is the below an implied or express duty
Advise the appropriate authorities in the event of loss or damage
Implied
Is an insurance policy intangible or tangible
Intangible
When is the onus on the insurers if they wish to decline to pay a claim
A) because of a policy exclusion
B) because of a policy condition
A) because of a policy exclusion
Is the below an implied or express duty
Do not hinder the insurer in the claims investigation process
Implied
Is the below an implied or express duty
A claim will be in valued if these duties aren’t performed
Implied
Is the below an implied or express duty
Take all steps to prevent a loss from spreading
Implied
Is the below a policy condition or claim condition
Notification to other authorities-
The policy must be notified immediately of any loss of damage cause malicious damage or theft
Claims conditions
Is the below an implied or express duty
A breach of conditions allows the insurer to repudiate the claim
Express
Is the below an implied or express duty
Specifically written into the contract and are usually found in the general policy conditions
Express
Is the below a policy condition or claim condition
Notification to insurers- the usual requirement is for the insured to notify insurer as soon as possible
Claim condition
Is the below a claim form or notification form
Provide sufficient info to permit the insurer to begin processing any claim
Claim form
Is the below a claim form or notification form
Establish whether the insured is entitled to indemnity under the policy- the insurer must satisfy itself that the loss is covered under the terms
Claim form
Is the below an implied or express duty
Some reinforce the implied conditions and therefore a contractual as well as common law requirement
Express
Is the below a policy condition or claim condition
Notification to insurers- claims for riot, civil commotion and malicious damage must be notified within 7 days as the insurers have a right of recovery against the policy but only have 42 dYs for the claim
capped to £1m
Claim conditions
How many hours of the day are telephones manned for:
A) 24 hours
B) 9-5
A) 24 hours
Is the below a policy condition or claim condition
Third party claims- insurers need to retain control over any liability claims and therefore require that the insured:
Immediately passed on unanswered any communications from third parties
Doesn’t admit to repudiate liability or offer to settle the claim
Allows insurers to take over and conduct any claim from or against third party
Claim
Is the below a policy condition or claim condition
Prevention of further damage- the insured must take reasonable precautions to prevent further damage
Claim condition
Is this a liability claim or theft claim
Details of any other insurances
Liability claim
Is the below a policy condition or claim condition
Assisting the claims process- the insured just provide insurers with all the info and help they require in respect of the claim
Claims condition
Do most insurers operate a freephone number for claims
Yes
Is the below a claim form or notification form
Provide sufficient info to permit the insurer to begin processing any claim
Claim form
What is the most common sense means of obtaining full details of the claim
A) a claim form
B) a notification form
A) a claim form
Is the below a claim form or notification form
Enable the insurer to take a preliminary view on whether there is likely to be a claim from a third party
Claim form
Is the below a claim form or notification form
Enable the insurer to consider whether any potential recovery rights may exist
Claim form
What two things require by insurers when a loss occurs for a claim form
Starting with claimants details (name, address, phone number, policy number)
Date, cause and circumstance or loss
Is this a liability claim or theft claim
Details of the persons or property injured or damaged and estimated amount of loss
This will enable insurers to put a reserve on a claim
Liability claim
Is the below an implied or express duty
Act as though uninsured and take all reasonable steps to minimise the loss
Implied
Is the below a policy condition or claim condition
Notification to insurer- if the initial notification is by telephone it needs to be followed up in writing within 30 days
Claims conditions
Is this a liability claim or theft claim
Details of any other interests in the property (mortgage company etc)
Liability claim
Is this a liability claim or theft claim
Details of any other party who may be liable for the loss
Liability claim
Other than the claim form what is the below supporting evidence
Receipts for purchases or repairs
A) property claims
B) theft claims
C) employers and PL claims
A) property claims
Other than the claim form what is the below supporting evidence
Police report.
A) property claims
B) theft claims
C) employers and PL claims
B) theft claim
Other than the claim form what is the below supporting evidence
A copy of the entry in the accident book
A) property claims
B) theft claims
C) employers and PL claims
C)EL and PL claims
Who needs to establish the following the insured or the insurers
Cover was in force at the time of the loss
Insurer
Who needs to establish the following the insured or the insurers
The claimant is either the insured named in the policy or a person entitled to indemnity
Insurer
Who needs to establish the following the insured or the insurers
The peril or event is covered by the policy
Insurer
Who needs to establish the following the insured or the insurers
The insured had taken reasonable steps to minimise the loss
Insurer
Who needs to establish the following the insured or the insurers
All conditions and warranties have been complied with
Insurers
Who needs to establish the following the insured or the insurers
The duty of disclosure was originally complied with
Insurer
Would the below claim be valid or partially met
Application of voluntary or compulsory excesses
Partially
Who needs to establish the following the insured or the insurers
The value of the loss is reasonable (looking at catalogues, price lists etc)
Insurers
Who needs to establish the following the insured or the insurers
No exceptions apply
Insurers
If the claim is valid what will happen
A) all requirements are met
B) they are only partially met
C) they are invalid
All requirements are met
Would the below claim be valid or partially met
The sun insured or limit of liability loss is greater than the limit the insureds recovery is limited to this amount
Partially met
What is the below
When a claim involves personal injury
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
D) doctor
Is the below a valid or invalid claim
Conditions are not complied with or if fraud can be proved
Invalid
Is the below a claim handler or loss adjuster:
Deal with all claims quickly and fairly
Distinguish between real and fraudulent claims
Settle claim costs effectively
Claims handler
What is the below:
Employee of the insurer whose role is to assess insurance losses where further investigation is required. Often involve visiting the insurers to obtain further details of the claim.
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
A) claims inspector
Does the below apply to the insurer or intermediaries
Avoid conflicts of interest, unless the circumstances have been disclosed to the customer
Intermediaries
What is the below
An independent person appointed by the insurance company: their role is to investigate the claim on the insurers behalf for which they are paid a fee.
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
B) loss adjuster
What is the below:
Checks the adequacy of the suns insured and the cause of loss
Ensures that any losses are minimised
Negotiates a settlement that is fair and acceptable
Recommend settlements to insurers
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
B) loss adjuster
What is the below
Complex liability claims they will be appointed to defend the claim on the insureds behalf and will pay any legal costs involved
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
Solicitor
Is the below a claim form or notification form
Enable the insurer to take a view as to the severity
Claim form
What are the 4 advantages of using recommended suppliers and repairers
Starting with the work will be carried out quickly
2- insurer can control the standard of work completed by the repairer
3- the insurer can control the costs involved
4- there is no need to obtain estimates
What is the below
Will consider the circumstances of the claim or determine whether the insured is legally liable and seek further info and ensure correct legal procedures are followed
A) claims inspector
B) loss adjuster
C) solicitor
D) doctor
C) solicitor
What is a reserve
A) an AP
B) realistic estimate of the cost of a claim
B) realistic estimate of the cost of a claim
What do insurers have to submit to the PRA each year
A) financial statements showing estimate of outstanding claims
B) financial statements showing reserves
A) financial statements showing estimate of outstanding claims
What will future projections produce it estimated claims figures are inaccurate
A) inappropriate rates
B) incorrect premiums
A) inappropriate rates
Why is it an importance element of an insurer to keep adequately estimated and up to date
A) a snapshot can be taken at any time of the profitability
B) to ensure compliance with the LRA
A) a snapshot can be taken at any time of the profitability
What 2 things will accurate claims reserving for an insurer involve starting with
1- examination of past data on claims including claims amounts
2- use of the past data and adjusting it to take account of any changes in the law inflation and external influences
If a claim is paid in stages what happens with the outstanding reserves
A)it has to be repaid
B) can be reduced in accordance with payment made
B) can be reduced in accordance with payment made
What will a central reserve cover
A) unknown exposures/ losses which may arise
B) it will reduce the company’s payment reserve
A) unknown exposures/ losses which may arise
What will a central reserve be put on
A) theft
B) asbestos
C) stress
B & C
What is the general rule for insurers handing claims
A) they are responsible of the claim regardless if its delegated authority
B) they aren’t responsible
A) they are responsible of the claim regardless if its delegated authority
Does the below apply to the insurer or insured
Handle claims promptly and fairly
Provide reasonable guidance to help a policyholder make a claim
Not unreasonably reject a claim
Settle claims promptly
Insurer
Does the below apply to the insurer or intermediaries
Forced any claim notification promptly to the insurer
Intermediary
What four claims can be settled
1- money
2- repairs
3- replacement
4- reinstatement
Does the below apply to the insurer or intermediaries
Manage conflicts of interest fairly
Intermediaries
Would the below claim be valid or partially met
Average clause
Partially
What under common law does the legal right have for claims
A) payment of money
B) recovery of goods
A) payment of money
What is the easiest way to grant indemnity
A) repair
B) money
B) money
What does a form of discharge do?
A) close the claim
B) avoids the possibility of the claim being reopened at a later date
B) avoids the possibility of the claim being reopened at a later date
Is the below mediation or conciliation
If they can reach an agreement they are free to pursue other legal remedies/ options
Mediation
In the case of liability insurance who is payment made to?
A) insured
B) third party
B) third party
Is reinstatement often used?
No
What does reinstating mean if the amount exceeding the sum insured
A) means accepting responsibility to pay the full amount
B) insurers are liable
A) means accepting responsibility to pay the full amount
Does the below apply to the insurer or intermediaries
Inform the customer if it’s acting for the insurer in relation to a claim under a policy
Intermediaries
What is salvage
A? The remaining value of the property
B) the scrap of the vehicle
A? The remaining value of the property
Is the below a fraud prevention or a fraud condition
Shared databases such as Claims and Underwriting Exchange.
Cue was established to help prevent multiple claims fraud and the misrepresentation of the claims history. Info is supplied by insurers and the database is shared by insurers
Fraud prevention
In the claims process it is important that opportunities for recovery
A) are not missed or ignored
B) are exempt
A) are not missed or ignored
Where she does the right or recovery arise
A) where lost or stolen property is found after the claim has been settled
B) where the third party is believed to have caused the loss or damage
A) where lost or stolen property is found after the claim has been settled
If the stolen item is recovered what will insurer prefer
A) to have the claim money reimbursed to them and the insured to keep the recovery item
B) insured can replaced it with previous claims
A) to have the claim money reimbursed to them and the insured to keep the recovery item
What is arbitration intended to deal with
A) disputes about the amount to be paid in settlement of a claim
B) providing liability
A) disputes about the amount to be paid in settlement of a claim
What is the judgement of the arbitrator
A) binding
B)in favour of the insurers
A) binding
Is the below benefits of alternative dispute resolution or arbitration
It is less costly than proceeding through a court trial
It can be timed to suit the parties
Settlements are confidential between the parties
Speed of completion
ADR
What happens if the claim money can’t be reimbursed under right of recovery
A) the insured will be allowed to keep the item
B) the insurer will try to arrange for the insured to take back the items and make a suitable allowance for the damage
B) the insurer will try to arrange for the insured to take back the items and make a suitable allowance for the damage
What does a mediator act as?
A) a facilitator
B) conciliator
Facilitator
Is the below mediation or conciliation
Any agreement reached to settle the dispute is made solely by the parties themselves
Mediation
Is the below a fraud prevention or a fraud condition
Cognitive interviewing and conversation management
Involves a structured approach to interactions such as telephone conversations with the claimant
Fraud prevention
What does the fraud condition mean:
A) can refuse to pay a claim and will declare the policy void from the fraudulent act without any refund of premium
B) if guilty of fraud the policy can be cancelled ab initio
A) can refuse to pay a claim and will declare the policy void from the fraudulent act without any refund of premium
Is the below mediation or conciliation
Less frequently form of ADR. The conciliators role is to lead the parties to a settlement
Conciliation
Is the below mediation or conciliation
The parties have to decide in advance whether they will be bound by the conciliators recommendations and if they agree to do this they will not usually have any recourse to the more formal court system
Conciliation
Is the FOS membership compulsory for insurers and intermediaries
Yes
What was the FOS formed under?
A) the financial services and markets act 2000
B) the FCA
C) ICOBS
A) the financial services and markets act 2000
Is the below an eligible complainant to the FOS
A trust with a net asset of less than £1m
Yes
Is the below an eligible complainant to the FOS
A Consumer
Yes
Is the below a fraud prevention or a fraud condition
Voice stress analysers
Lie detectors
Fraud prevention
Is the below a fraud prevention or a fraud condition
Insurance Fraud Register (IFR) established in 2012 and aims to encourage firms to share info to prevent fraudsters moving from insurer to insurer in a bit to deter offenders
Fraud prevention
Is the below an eligible complainant to the FOS
A charity with an annual income of less than £1m
Yes
How long does the customer have to send the complaint to FOS
A) 8 weeks
B) 12 months
C) 6 months
C) 6 months
Any decisions which the FOS makes where the award is up to £150k is
A) binding on insurance and intermediaries
B) binding on insurers only
A) binding on insurance and intermediaries
Is the below a fraud prevention or a fraud condition
Insurance Fraud Investigators Group
Organisations dedicated to the detection and prevention of insurance fraud. Non profit. Members include insurers, lawyers, loss adjusters and investigation agencies
Fraud prevention
Under the ABI how much did 125,000 cases of frauds cost in 2016
A) 1 billion
B) 1.3 billion
B) 1.3 billion
Is the below an eligible complainant to the FOS
A micro enterprise who employs fewer than 10 people and a turnover of less than 2m
Yes
What are four types of fraudulent claims starting with bogus claims
2- misrepresentation of claims
3- inflated claims
4- multiple claims
Is the below a fraud prevention or a fraud condition
Specialist software
Fraud prevention
Is the below a fraud prevention or a fraud condition
Insurance fraud Bureau/ tackles the problem of organised fraud and analyses data from various industry databases
Fraud prevention
Is the below possible indicator of fraudulent claim
Made soon after policy inception
Where the insured had no documentation where claims are inconsistent
Where the loss wasn’t report to police
Poor claims history
Yes
What offered new opportunities to fight fraud
A) social media and internet
B) social media only
A) social media and internet
Is the below a fraud prevention or a fraud condition
Claims handlers
Fraud prevention
