Claim Procedures Flashcards
What is onus of proof?
Relates to two issues;
1. Proof of the cause of loss
2. The extent of financial loss
Who has the onus to prove the cause of loss?
The policyholder
Who has the duty to prove that the cause results from an excluded cause?
The insurer
What is the purpose of acceptance forms?
To demonstrate the the PH has agreed to a final settlement.
Are acceptance forms always required by insurers?
Not always
What should the acceptance form clearly state? (5)
- Subject to insurers approval (therefore not binding on insurers)
- Amount proposed stated in words and figures
- Statement that offer is in full & final settlement
- Policy number included
- Risk address included
What does validation of quantum concern?
Verification of the amount involved in the loss.
What are 2 ways losses can be validated in terms of quantum?
- Measuring & counting
- Reference to stock records
What does FCA Handbook ICOBS 8 stand for?
Financial Conduct Authority Handbook, Insurance Conduct of Business
ICOBS 8.1.1?
Insurer must;
1. Handle claims promptly and fairly
2. Provide reasonable guidance to help the PH make a claim & appropriate info on it’s progress
3. Not unreasonably reject a claim (incl terminating & avoiding a policy)
4. Settle claims promptly once settlement terms are agreed
ICOBS 8.1.2?
Situations where it is unreasonable to reject a consumer PH’s claim.
Unreasonable except where there is evidence of fraud if it is;
1. Non-disclosure of a fact material to the risk which PH could not reasonably be expected to have disclosed
2. By non-negligent misrepresentation of a fact material to the risk
3. Breach of warranty or condition, unless circs are connected to the breach
ICOBS 8.1.3?
a “qualifying misrepresentation is one made by a consumer before a consumer insurance contract was entered into or varied if;
1. Consumer made misrep in breach of duty set out in Consumer Insurance (D&R) Act 2012
2. Insurer shows that w/o misrep they wouldn’t have entered into contract at all or would have done so on different terms
What is the mission of the Insurance Fraud Bureau (IFB)?
“To lead the insurance industry’s collective fight against organised fraud.”
How do the IFB support the insurance industry? (5)
- Provide access to considated insurance industry data.
- Provide reactive reports & info
- Provide proactive reports & info
- Provide intelligence
- Provide application fraud products
How do the IFB support law enforcement?
Plays an important role in assisting police investigations into organised insurance fraud & help bring fraudsters to justice.
Forms of discharge?
- For liability claims
- Third party agreement to settlement and no further claims to be made.
Assignment?
Allows the rights of the claim to pass to another party e.g purchaser of property
Mandates?
Formal agreement that the claim can be presented/managed by someone other than the insured, e.g loss assessor.
Provide example on how the IFB provides insight into some of the fraudulent means used to gain money illegitimately from insurers?
Cash for crash
staging motor incident solely for financial gain.
