Claims department

Question 1

What does the consumer insurance contracts act apply to?

Answer 1

Contracts of indemnity and non-indeminity for less than €3

Question 2

Define a claim

Answer 2

A formal demand to an insurance company for reimbursement for a loss or damage to an insured object in accordance with the terms of the policy

Question 3

What does the way in which a claim is handled depend on?

Answer 3

• Class of business (Personal or commercial)
• Type of cover
• Amount of claim - decide hoe much investigation is necessary

Question 4

What is included in the technical department

Answer 4

Claims, underwriting and reinsurance

Question 5

Who does a broker work for?

Answer 5

Insured

Question 6

What is a broker

Answer 6

An agent of the insured that is an accredited expert in insurance. They must deal with at least 5 insurers and they are liable for any mistakes they make in terms of whats covered and whats not.

Question 7

If a broker says something is covered is it?

Answer 7

Only if its in the policy

Question 8

Who does an agent work for?

Answer 8

Inured

Question 9

What is the difference between an agent and a broker?

Answer 9

An agent can deal with less than 5 insurers

Question 10

Who does a tied agent work for?

Answer 10

The insurer

Question 11

Who is liable for any mistakes a tied agent makes?

Answer 11

The insurer

Question 12

Who hires a loss adjuster

Answer 12

Insurer

Question 13

Who does the loss adjust or work for and what do they do?

Answer 13

They work for the insured and they see if a valid claim exists.

Question 14

What does a loss adjuster do?

Answer 14

• Investigate the claim
• Objectively evaluate
• Investigate quantum
• Report to the insurer whether to settle or defend and recommend a reserve amount

Question 15

Who hires a loss assessor

Answer 15

The insured

Question 16

What does a loss assessor do?

Answer 16

Investigates the claim on behalf of the insured

Question 17

What are insurers obligations under the CPC (consumer protection code) in regard to loss assessors?

Answer 17

Must inform insured of there right to hire one

Question 18

Preambles

Answer 18

Defines the parties

Question 19

Schedule

Answer 19

Details of what (person or property) is covered

Question 20

Definitions

Answer 20

Defines words in the policy that could be misinterpreted

Question 21

Cover in a policy

Answer 21

Defines perils insured and any exclusions

Question 22

General conditions

Answer 22

Any word or expression to which a specific meaning has been attached in any part of the policy seduces and sections specifying the meaning wherever it may appear.

Question 23

Endorsements

Answer 23

Changes to the policy after is accepted

Question 24

What supersedes a general contract

Answer 24

The scedules

Question 25

Precedent to liability

Answer 25

Conditions must be satisfied before an insurer becomes liable to pay the claim. Eg: Insurer can’t deny claim because of late notification time unless something happened to make it worse - CIA 2019

Question 26

What immediate actions should you do if you suffer a loss of an insured item?

Answer 26

Take all reasonable actions to prevent further damage

Question 27

Where is the notifications process set out?

Answer 27

The policy