Claims Awareness Flashcards
What 2 things must the insured prove when submitting a claim?
That an insured peril arose
The amount of the loss
How can notification of a claim be made?
In writing, by telephone, by e-mail
What do the responses to the questions on a claim form allow the insurer to do?
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
List 3 things a policyholder can provide as supporting evidence when presenting a claim?
Original purchase receipt Replacement estimate Crime reference number Contractors estimate for repairs Photograph of damage Evidence of a storm Doctor/medical certificate
What must a third party demonstrate when making a claim against a policyholder?
The insured has been negligent
Under the Limitation Act (1980), what are the timescales under which a personal injury claim and a property damage claim must be notified?
Personal injury – 3 years
Property damage – 6 years
How many key stages are there under the MOJ reforms?
Three
When did the MOJ reforms commence for motor & how are new claims submitted?
April 2010, via the MOJ portal
What 4 areas are considered when deciding where a claim should be handled?
The line of business
The type of claim
The value of the claim
Technical complexity of the claim
What are the 4 settlement options available for policyholder claims?
Repair
Replacement
Reinstatement
Cash
List 3 things that could affect the amount paid in settlement?
Sum insured
Policy limit
Excess
Betterment
What is Leakage?
An overpayment on a claim that is not actually covered
Give an example of a claim where a recovery could be pursued:
Fire damage caused by a car crashing into a shop and catching fire
What is meant by ‘Quantum’?
The agreed financial value or settlement of any claim
List 3 common fraud indicators:
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