Claims settlement Flashcards

1
Q

In what 4 circumstances might an insurer refuse to pay a claim?

A
  1. Cover was never in force
  2. Breach of a relevant warranty
  3. Breach of a policy condition
  4. Fraud
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2
Q

What are partially met claims?

A

Where a claim is valid but some terms and conditions mean that the full value claim settlement is not made.

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3
Q

How would you calculate a claim under the pro rata average condition?

A

Sum insured / value of property at risk x loss

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4
Q

What is a deductible and why is it used?

A

A deductible is a large excess.

An insured (usually a large commercial concern) may wish to limit its cover to large claims and be its own insurer for smaller claims.

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5
Q

What is a franchise?

A

An excess where claims are paid in full once the claim exceeds a specific threshold.

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6
Q

How are claims settlements made?

A
  • Payment of money [liability, personal accident and pecuniary insurance (e.g. business interruption) claims].
  • Paying repairs (Motor Insurance claims)
  • Replacement (Glass Insurance claims, some home contents claims)
  • Reinstatement (sometimes property)
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7
Q

In what situations might ex-gratia payments be made?

A
  • where an exclusion is a borderline one
  • where there is a genuine oversight by the insured (such as an administrative error)
  • where hardship would be created
  • to preserve good business relationships.
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8
Q

What are the key features of the ABI Memorandum of Understanding - Subrogated Motor Claims?

A
  • consistency in authorising repair costs, regardless of whether recovery is likely
  • claims must represent the net costs to the insurer
  • supporting documentation should be volunteered
  • legal costs should be avoided, with proper notice being given of any intended proceedings.
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9
Q

What is RIPE (Reduction in Paper Exchange)?

A

An agreement in respect of motor vehicle damage claims where repair documentation does not need to be provided, with each insurer trusting the other.

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10
Q

What is the purpose of the ABI Personal Effects Contribution Agreement?

A
  • avoid adverse publicity for insurers
  • avoid costly and unnecessary handling of small contribution payments
  • set rules for contribution between participating insurers

Deals with Claims for the loss of personal effects covered by two or more policies. (Applies regardless of any policy provisions)

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11
Q

What does the ABI Personal Effects Agreement cover?

A
  • Motor accidents/thefts
  • Specified items
  • All other circumstances (amount over £125 and the other policy is not a motor policy)
  • No claims discount
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12
Q

What does MIB stand for and what is its purpose?

A

Motor Insurers Bureau (Established 1946)

Administer a central compensation fund for innocent parties unable to recover compensation following a road accident.

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