Claims Awareness Flashcards

1
Q

What 2 things must the insured prove when submitting a claim?

A

That an insured peril arose

The amount of the loss

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2
Q

How can notification of a claim be made?

A

In writing, by telephone, by e-mail

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3
Q

What do the responses to the questions on a claim form allow the insurer to do?

A

Establish whether the insured is entitled to indemnity under the policy
Establish the likely size of the claim
Establish if there is any potential for recovery from a third party

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4
Q

List 3 things a policyholder can provide as supporting evidence when presenting a claim?

A
Original purchase receipt
Replacement estimate
Crime reference number
Contractors estimate for repairs
Photograph of damage
Evidence of a storm
Doctor/medical certificate
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5
Q

What must a third party demonstrate when making a claim against a policyholder?

A

The insured has been negligent

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6
Q

Under the Limitation Act (1980), what are the timescales under which a personal injury claim and a property damage claim must be notified?

A

Personal injury – 3 years

Property damage – 6 years

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7
Q

How many key stages are there under the MOJ reforms?

A

Three

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8
Q

When did the MOJ reforms commence for motor & how are new claims submitted?

A

April 2010, via the MOJ portal

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9
Q

What 4 areas are considered when deciding where a claim should be handled?

A

The line of business
The type of claim
The value of the claim
Technical complexity of the claim

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10
Q

What are the 4 settlement options available for policyholder claims?

A

Repair
Replacement
Reinstatement
Cash

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11
Q

List 3 things that could affect the amount paid in settlement?

A

Sum insured
Policy limit
Excess
Betterment

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12
Q

What is Leakage?

A

An overpayment on a claim that is not actually covered

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13
Q

Give an example of a claim where a recovery could be pursued:

A

Fire damage caused by a car crashing into a shop and catching fire

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14
Q

What is meant by ‘Quantum’?

A

The agreed financial value or settlement of any claim

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15
Q

List 3 common fraud indicators:

A

Claims made just after the inception of a policy
Threatening behaviour &/or excessive pressure to settle the claim
Changes to estimates and accounts
Lack of co-operation
Inconsistency in details of the circumstances of the claim

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16
Q

What are ‘Uninsured Losses’?

A

The costs of claims that are not insured