CII IF4 Flashcards
When an insurance claim is made, who is responsible for proving the claim is valid? Select one: a. The insured. b. The insurer. c. The solicitor. d. The assessor.
b. The Insured
What is the amount of a claim known as? Select one: a. Cost. b. Value. c. Liability. d. Quantum.
Quantum.
When Patrick took out household insurance, there was a condition that he must fit an approved burglar alarm. He failed to do so and this came to light when he submitted a valid claim for a fire in his kitchen. How would the insurer treat the claim for the fire?
Select one:
a. They would pay the claim for the fire.
b. They would pay the claim but the amount paid would be subject to a ‘limit of liability’.
c. They would cancel the policy from outset and not pay the claim for the fire.
d. They would pay the claim for the fire but this would be subject to ‘averaging’.
a. They would pay the claim for the fire.
A comprehensive private car policy has a voluntary excess of £250 and a compulsory excess of £500. In the event of a claim for £1,250 accidental damage, how much will the insured have to pay? Select one: a. £1,250. b. £500. c. £250. d. £750.
d. £750
Under what circumstance might an insurance claim be subject to the principle of ‘averaging’?
Select one:
a. Where the peril is insured by more than one insurer.
b. Where facts have been misrepresented by the insured.
c. Where a warranty has not been met by the insured.
d. Where there is under-insurance.
d. Where there is under-insurance.
Under common law, the insured has a duty to:
Select one:
a. take all reasonable steps to minimise the loss.
b. report all incidents to the local police authority.
c. maintain a record of all elements of the loss.
d. declare the full value of the subject matter of the insurance.
take all reasonable steps to minimise the loss.
In which part of the insurance policy would the policyholder's express duties usually be detailed? Select one: a. Policy schedule. b. Policy warranties. c. Policy summary. d. Policy conditions.
Policy conditions.
With household insurance policies, within what timescale is the policyholder normally required to notify the insurer of a claim? Select one: a. Promptly. b. Five working days after the event. c. Seven working days after the event. d. Next working day after the event.
Promptly.
Who will normally be involved in a large and complex claim? Select one: a. An engineer. b. A loss adjuster. c. A risk surveyor. d. A loss assessor.
A loss adjuster.
What type of expert may be used to estimate rebuilding costs, as part of the claims investigation process? Select one: a. Accountant. b. Lawyer. c. Mechanical engineer. d. Surveyor.
Surveyor.
A fire at John's premises caused damage to a water pipe with resultant water damage to the building and contents below. What is the proximate cause of the loss? Select one: a. Flood. b. Accidental damage. c. Fire. d. Escape of water.
Fire.
To establish the proximate cause of a loss and determine policy liability, the insurer will:
Select one:
a. check that all conditions and warranties have been complied with.
b. look at whether the insured has taken all reasonable steps to minimise the loss.
c. check that the value of the loss is reasonable.
d. look at the relationship between the peril and the loss.
look at the relationship between the peril and the loss.
What is the minimum level of private motor insurance required to comply with UK motoring legislation? Select one: a. Third party only. b. Road Traffic Act only. c. Third party, fire and theft only. d. Comprehensive.
Road Traffic Act only.
How does cover offered by a commercial vehicle policy typically differ from a private motor insurance policy?
Select one:
a. It is unlikely to allow use of the vehicle for social, domestic or pleasure purposes.
b. There is unlikely to be a limit on third party damage cover.
c. It is unlikely to cover personal effects.
d. There are likely to be no restrictions placed on driving other cars.
It is unlikely to cover personal effects.
Which buildings insurance peril often has an exclusion if the property is unoccupied? Select one: a. Flood. b. Impact. c. Explosion. d. Escape of water.
Escape of water.
Commercial property insurance will often include cover against theft. What is the best definition of a ‘first loss’ basis of cover?
Select one:
a. The maximum amount payable during a period of insurance.
b. An amount limited to the market value of the subject matter.
c. An amount payable after deductions for wear and tear.
d. An amount that is less than the total value of the subject matter.
An amount that is less than the total value of the subject matter.
Under a theft policy, what is a common extension? Select one: a. Fire and explosion. b. Cash and bank notes. c. New for old cover. d. Temporary removal.
Temporary removal.
Commercial property insurance will often provide cover against the loss or theft of money held on commercial premises. What type of loss is NOT typically covered by a standard money policy? Select one: a. Theft of postage stamps. b. Theft of credit cards. c. Theft of currency notes. d. Theft of cheques.
Theft of credit cards.
What type of insurance would cover a company against the costs arising out of the need to take action in the courts or to defend an action brought against them? Select one: a. Theft insurance. b. Employers' liability insurance. c. Legal expenses insurance. d. Business interruption insurance.
Legal expenses insurance.
A business interruption policy typically insures gross profits and:
Select one:
a. the costs of any criminal prosecution defence.
b. wages.
c. the cost of raw materials.
d. liability resulting from the employer’s negligence.
wages.
What is the minimum sum insured required by law under an employers’ liability insurance policy? Select one: a. £2.5 million. b. £1 million. c. £5 million. d. £10 million.
c. £5 million.
A benefit policy is a contract to pay:
Select one:
a. all monies within a defined period.
b. a loss over a specified indemnity period.
c. a sum of money should a defined event occur.
d. a sum of money equivalent to an agreed value.
c. a sum of money should a defined event occur.
A personal accident and sickness policy will typically make payments for sickness where disablement arises:
Select one:
a. from sickness or disease which lasts at least one month.
b. due only to sickness which lasts 6 months or more.
c. from sickness or disease and prevents the insured from following their usual occupation.
d. due only to sickness requiring hospitalisation.
c. from sickness or disease and prevents the insured from following their usual occupation.
With sickness insurance, what is a ‘franchise’?
Select one:
a. It is the minimum period of time the insured must have been in employment before a claim can be considered under the policy.
b. It is the maximum duration that benefits are payable for.
c. It is the maximum amount of benefit that is payable under the policy.
d. It is a period of time or financial threshold below which a policy would not provide an indemnity.
d. It is a period of time or financial threshold below which a policy would not provide an indemnity.
What is typically the maximum number of weeks a personal accident insurance will pay for temporary total disablement? Select one: a. 104. b. 26. c. 52. d. 100.
a. 104. chapter reference 2J3
Within an insurance company, which role is most likely to decide whether submitted claims are genuine or fraudulent? Select one: a. Claims handler. b. Underwriter. c. Customer services manager. d. Accounts manager.
a. Claims handler. chapter reference 3A
When dealing with claims, an insurer will look to ensure high levels of customer satisfaction by:
Select one:
a. offering a third-party resolution service for unresolved complaints.
b. setting out clear service standards.
c. following relevant FCA rules and guidance.
d. ensuring all claims are dealt within a set timescale.
b. setting out clear service standards.
chapter reference 3B
A road traffic accident occurred when the insured, Mr Jones, and a third party, Mr Smith, both jumped amber traffic lights, resulting in a collision. In practice, if Mr Smith only had third party insurance, who is he most likely to present his claim to and what is the most likely outcome in this case?
Select one:
a. His own insurer and he would be unlikely to receive full compensation.
b. His own insurer and he would be likely to receive full compensation.
c. Mr Jones and he would be unlikely to receive full compensation.
d. Mr Jones’s insurer and he would be unlikely to receive full compensation.
c. Mr Jones and he would be unlikely to receive full compensation.
chapter reference 3C
What is the primary objective of claims reserving?
Select one:
a. To meet the FCA’s solvency requirements.
b. To provide information for inclusion in the annual accounts.
c. To estimate the future cost of claims.
d. To ensure the insurance company can remain profitable.
c. To estimate the future cost of claims.
chapter reference 3D
Which organisation takes the lead on fraud prevention for the insurance industry in the UK?
Select one:
a. Crimestoppers.
b. The Association of British Insurers.
c. The Insurance Fraud Bureau.
d. The Commercial Fraud Lawyers Association.
c. The Insurance Fraud Bureau.
chapter reference 3E1
Which database contains details of all total loss and theft motor claims?
Select one:
a. Motor Insurance Database [MID].
b. Motor Insurance Anti-Fraud and Theft Register [MIAFTR 2].
c. Claims and Underwriting Exchange [CUE].
d. Driver and Vehicle Licensing Agency [DVLA].
b. Motor Insurance Anti-Fraud and Theft Register [MIAFTR 2].
chapter reference 3E1
Which client is an insurer most likely to investigate further for potential fraud?
Select one:
a. Paul, who has recently added accidental damage cover to his household policy and is making a claim for accidental damage to his hall, stairs and landing carpet.
b. Liz, who is increasing the sum insured on her building policy to account for a new extension that has just been built.
c. Oscar, who sustained a head injury at work and is struggling to remember the details of his personal accident claim.
d. Jacquie, who wishes to increase her third party fire and theft insurance to comprehensive and subsequently makes a claim for windscreen damage.
a. Paul, who has recently added accidental damage cover to his household policy and is making a claim for accidental damage to his hall, stairs and landing carpet.
chapter reference 3E2
When dealing with an insurance claim where there has been a fraudulent act or omission, the view of the Financial Ombudsman Service is that the insurer:
Select one:
a. can decline the claim and any subsequent claims on the basis that fraudulent claimants must not be allowed to believe that they have nothing to lose by making a fraudulent claim.
b. can decline the claim in full as the contract terms have been breached, irrespective of the impact on the insurer’s ultimate liability.
c. must pay the claim but may apply a reasonable deduction reflecting the severity of the act.
d. must pay the claim in full if the act makes no difference to the insurer’s ultimate liability.
d. must pay the claim in full if the act makes no difference to the insurer’s ultimate liability. chapter reference 3E3
Under the rules contained in the Insurance: Conduct of Business Sourcebook, for how long should firms retain non-advice records? Select one: a. For 3 years. b. For as long as is relevant. c. For a reasonable period of time. d. For 6 years.
b. For as long as is relevant.
chapter reference 3F1
Under the Insurance Act 2015, who is required to make a fair presentation of a risk to an insurer? Select one: a. Consumers and charitable trusts only. b. Commercial customers. c. Consumers. d. All customers.
b. Commercial customers.
chapter reference 3F3
The Financial Ombudsman Service deals with unresolved complaints. To be eligible, the guidance states that a small business must employ fewer than:
Select one:
a. 10 persons and have a turnover of no more than £3 million.
b. 50 persons and have a turnover of less than £3 million.
c. 50 persons and have a turnover of less than £6.5 million.
d. 10 persons and have a turnover of no more than €2 million.
c. 50 persons and have a turnover of less than £6.5 million.
chapter reference 3G1A
If Max has had a complaint upheld by the Financial Ombudsman Service for £15,000, he:
Select one:
a. does not need to accept the award but it is binding on the insurer.
b. does not need to accept the award but if not, he is unable to pursue a claim through the courts instead.
c. must accept the award but he is still able to pursue a claim for a higher amount through the courts instead.
d. must accept the award and it is also binding on the insurer.
a. does not need to accept the award but it is binding on the insurer.
chapter reference 3G1A
A dispute over a claim has gone to arbitration which found in favour of the insurer. If the insured still disputes the facts, what options, if any, would they have to pursue the matter further?
Select one:
a. None.
b. The tribunal decision is binding but there is an appeal process that may be followed.
c. The tribunal decision is not binding and they may pursue actions through the courts.
d. The tribunal decision is not binding and they may pursue actions through the Financial Ombudsman Service.
a. None.
chapter reference 3G1B
In addition to adjudication, what are the other two adjudicative options for resolving claim disputes?
Select one:
a. Mediation and reconciliation.
b. Arbitration and reconciliation.
c. By expert resolution and mediation.
d. Arbitration and by expert determination.
d. Arbitration and by expert determination.
chapter reference 3G2A
Beth has submitted a claim on a policy to her insurer which she believes has taken too long to finalise. Under the FCA’s fair treatment of customers, what outcome is this most likely to have breached?
Select one:
a. Outcome 3: consumers are provided with clear information and are kept appropriately informed before, during and after the point of sale.
b. Outcome 2: products and services marketed and sold in the retail market are designed to meet the needs of identified consumer groups and are targeted accordingly.
c. Outcome 4: Where consumers receive advice, the advice is suitable and takes account of their circumstances.
d. Outcome 6: consumers do not face unreasonable post-sale barriers.
d. Outcome 6: consumers do not face unreasonable post-sale barriers.
chapter reference 3H1
In motor insurance, what is the 'claim form' called? Select one: a. A motor incident report form. b. A motor report form. c. An accident report form. d. A vehicle incident report form.
c. An accident report form.
chapter reference 4A1
Under a household policy, contents are regarded as either durable goods or consumer goods. What is an example of consumer goods? Select one: a. Freezers. b. Clothing. c. Dishwashers. d. Vacuum Cleaners.
b. Clothing.
chapter reference 4A3A
The indemnity sum for the loss or damage to a building is calculated as the cost of repair or:
Select one:
a. reinstatement at the time of loss less an allowance for betterment.
b. reinstatement at the time of loss plus an allowance for betterment.
c. replacement at the time of loss.
d. replacement at the time of loss without adjustment.
a. reinstatement at the time of loss less an allowance for betterment.
chapter reference 4A3B
What type of insurance policy is LEAST likely to be subject to fraudulent claims? Select one: a. Extended warranty. b. Travel. c. Motor. d. Household.
a. Extended warranty.
chapter reference 4A5
What type of claim is dealt with under a property insurance policy? Select one: a. Legal expenses. b. Public liability. c. Glass. d. Business interruption.
c. Glass.
chapter reference 4B
Who is responsible for payment of the loss adjuster's costs? Select one: a. The insured. b. The insurer. c. The broker. d. The assessor.
b. The insurer.
chapter reference 4B1A
Who would usually arrange repairs for a glass claim? Select one: a. A loss adjuster. b. An engineer. c. An approved repairer. d. A surveyor.
c. An approved repairer.
chapter reference 4B1D
With employers’ liability insurance, what will a successful claim have to demonstrate?
Select one:
a. The employer has been negligent.
b. The loss occurred on the employer’s premises.
c. An injury only has been sustained.
d. The event resulting in the claim occurred during normal working hours, not whilst working overtime.
a. The employer has been negligent.
chapter reference 4B3
On what basis are public liability policies written? Select one: a. On a losses-occurring basis. b. On a claims-made basis. c. On a claims-reported basis. d. On a losses-made basis.
a. On a losses-occurring basis.
chapter reference 4B3
A consumer has been told by the legal helpline offered under her policy that it is unable to help her. This is because she requires advice on:
Select one:
a. whether she might be able to make a claim under her insurance policy.
b. her legal rights.
c. whether she might be able to defend a claim being made against her.
d. how she should word a contract that she needs for business purposes.
d. how she should word a contract that she needs for business purposes.
chapter reference 4C1
Many motor insurers use an approved repairer. What is LEAST likely to be a benefit to them of doing so? Select one: a. Cost. b. Speed of claims reporting. c. Convenience. d. Competence of repairers.
b. Speed of claims reporting.
chapter reference 4C2
What types of claims does the Low Value Personal Injury Pre-action Protocol deal with?
Select one:
a. Road traffic accident, Employers’ Liability, and Public Liability personal injury claims only.
b. Road traffic accident, Employers’ Liability, and all Public Liability personal injury and property claims.
c. Employers’ Liability and Public Liability personal injury claims only.
d. Road traffic accident and Public Liability personal injury claims only.
a. Road traffic accident, Employers’ Liability, and Public Liability personal injury claims only.
chapter reference 4D2
What is the maximum limit for personal injury claims to be processed via the MOJ Portal? Select one: a. £10,000. b. £15,000. c. £20,000. d. £25,000.
d. £25,000.
chapter reference 4D2
The use of Information Technology in claims handling must take account of two characteristics of insurance claims. These are volume and: Select one: a. quantum. b. ambiguity. c. value. d. complexity.
d. complexity.
chapter reference 5A2
In what way may the use of Information Technology [IT] cause a possible adverse cash flow effect?
Select one:
a. Claims may be dealt with on the basis of assumption rather than judgement.
b. Reinsurance recoveries may not be as fast as claims payments.
c. Productivity at the insurance company may increase.
d. The IT system may be difficult to operate.
b. Reinsurance recoveries may not be as fast as claims payments.
chapter reference 5A4B
What does an insurer need to take into account under GDPR, when considering its online marketing?
Select one:
a. There is no need to retain records relating to how consent was given.
b. People have to positively give their consent to opt-in to marketing.
c. All types of personal data are treated equally.
d. It may ‘pre-tick’ a person’s consent to receive marketing.
b. People have to positively give their consent to opt-in to marketing.
chapter reference 5A5
Using a skilled resource from outside the company is called: Select one: a. resourcing. b. outsourcing. c. decentralising. d. delegating.
b. outsourcing.
chapter reference 5C1
Whose job is it to negotiate a settlement within the terms of a policy, that is fair to both the insured and the insurer? Select one: a. Loss manager. b. Loss assessor. c. Loss adjuster. d. Loss adviser.
c. Loss adjuster.
chapter reference 5C2
In the event of a business interruption claim, who may be appointed to ensure business continuity? Select one: a. A disaster recovery company. b. A loss assessor. c. A surveyor. d. An outsourcing company.
a. A disaster recovery company.
chapter reference 5C3
When a claim is settled by reinstatement, who is ultimately responsible for ensuring that the work is carried out?
Select one:
a. The insurer.
b. The insured.
c. The loss adjuster.
d. The company undertaking the reinstatement.
a. The insurer.
chapter reference 6A4