Claims department Flashcards
What does the consumer insurance contracts act apply to?
Contracts of indemnity and non-indeminity for less than €3
Define a claim
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
What does the way in which a claim is handled depend on?
- Class of business (Personal or commercial)
- Type of cover
- Amount of claim - decide hoe much investigation is necessary
What is included in the technical department
Claims, underwriting and reinsurance
Who does a broker work for?
Insured
What is a broker
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.
If a broker says something is covered is it?
Only if its in the policy
Who does an agent work for?
Inured
What is the difference between an agent and a broker?
An agent can deal with less than 5 insurers
Who does a tied agent work for?
The insurer
Who is liable for any mistakes a tied agent makes?
The insurer
Who hires a loss adjuster
Insurer
Who does the loss adjust or work for and what do they do?
They work for the insured and they see if a valid claim exists.
What does a loss adjuster do?
- Investigate the claim
- Objectively evaluate
- Investigate quantum
- Report to the insurer whether to settle or defend and recommend a reserve amount
Who hires a loss assessor
The insured
What does a loss assessor do?
Investigates the claim on behalf of the insured
What are insurers obligations under the CPC (consumer protection code) in regard to loss assessors?
Must inform insured of there right to hire one
Preambles
Defines the parties
Schedule
Details of what (person or property) is covered
Definitions
Defines words in the policy that could be misinterpreted
Cover in a policy
Defines perils insured and any exclusions
General conditions
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.
Endorsements
Changes to the policy after is accepted
What supersedes a general contract
The scedules
Precedent to liability
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
What immediate actions should you do if you suffer a loss of an insured item?
Take all reasonable actions to prevent further damage
Where is the notifications process set out?
The policy
