Claims department Flashcards

1
Q

What does the consumer insurance contracts act apply to?

A

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

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2
Q

Define a claim

A

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

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3
Q

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

A
  • Class of business (Personal or commercial)
  • Type of cover
  • Amount of claim - decide hoe much investigation is necessary
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4
Q

What is included in the technical department

A

Claims, underwriting and reinsurance

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5
Q

Who does a broker work for?

A

Insured

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6
Q

What is a broker

A

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.

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7
Q

If a broker says something is covered is it?

A

Only if its in the policy

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8
Q

Who does an agent work for?

A

Inured

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9
Q

What is the difference between an agent and a broker?

A

An agent can deal with less than 5 insurers

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10
Q

Who does a tied agent work for?

A

The insurer

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11
Q

Who is liable for any mistakes a tied agent makes?

A

The insurer

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12
Q

Who hires a loss adjuster

A

Insurer

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13
Q

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

A

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

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14
Q

What does a loss adjuster do?

A
  • Investigate the claim
  • Objectively evaluate
  • Investigate quantum
  • Report to the insurer whether to settle or defend and recommend a reserve amount
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15
Q

Who hires a loss assessor

A

The insured

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16
Q

What does a loss assessor do?

A

Investigates the claim on behalf of the insured

17
Q

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

A

Must inform insured of there right to hire one

18
Q

Preambles

A

Defines the parties

19
Q

Schedule

A

Details of what (person or property) is covered

20
Q

Definitions

A

Defines words in the policy that could be misinterpreted

21
Q

Cover in a policy

A

Defines perils insured and any exclusions

22
Q

General conditions

A

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.

23
Q

Endorsements

A

Changes to the policy after is accepted

24
Q

What supersedes a general contract

A

The scedules

25
Q

Precedent to liability

A

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

26
Q

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

A

Take all reasonable actions to prevent further damage

27
Q

Where is the notifications process set out?

A

The policy