IF4.4 Claims handling procedures Flashcards
7 aspects to motor claims process
- the insured is bound to notify insurers on all claims accidents (whether they intend to claim or not)
- at notification the insured should fill out a accident report form (ARF) over phone or internet.
- the insurer will set up a file with all relevant information (usually electronic)
- Understand if the policy is in force & indemnity due. Repair work is done.
- claims in other sections of the policy are reviewed
- third party claims. The insurer will identify who is at fault.
- degree of negligence must be established.
For non-comprehensive cover the insured must still…
report all accidents.
Health insurance claims proces
- first the insurer will check valid insurance is in place & that policy conditions have been met
- supporting evidence may need to be submitted
Health insurance supporting evidence is required when
- death (death certificate, coroner inquest)
- loss of limb must be proved
- disablement needs medical certificates
why is health insurance claims easier
benefit policy - sums have already been approved.
Contents insurance claims
new for old replacement once proof of ownership.
Building insurance claims
- Loss adjusters are used to provide experts opinions on substantial damage.
- repair or reinstate building (up to repair value at time of loss less the allowance for betterment)
Betterment
when certain aspects of the repaired property are in better condition than they were before
Travel Claims: personal accident or sickness benefits
the considerations that apply to health claims generally apply. Set amount at policy inception, just need proof to pay out.
Travel Claims: travel interruption or delay
The insurer can make its own enquires with travel authorities or ask that the insured obtain necessary proof.
Travel Claims: medical or associated espenses
authorised prior to treatment (control costs) or in an emergency medical expenses are claimed after treatment are scrutinised prior to payment.
Travel Claims: baggage, personal effects and money
proof of purchase for items required as well as confirmation that the loss has been reported to the authorities.
Extended Warranties claims process
claims settlement is simply repairing or replacing the appliance (claim forms are rarely required)
pet insurance claims process
covers vet fees (following injury, illness or death), theft of pet(advertising costs), boarding fees(if you are hospitalised) & liability cover for dogs.
Invoices are sent to insurers along with proof of the event.
commercial property claims process: insured duties
- notify the insurer immediately
- mitigate their losses
- deliver to the insurer full information about the property lost
- provide proof of loss
commercial property claims process: Insurers duties
establish:
- whether the policy is in force
- whether the claim is valid
- whether the policy covers the loss
loss adjustor
investigates the loss (cause and extent) and prepares a report recommending the amount payable under the terms of the policy. Ensure that the insured has complied with any related endorsements or warranties.
loss assessor
negotiate with the adjustor and the insurer on behalf of the insured.
commercial property claims process: theft claims
same as any property claim but a police report is usually required
commercial property claims process: glass claims
same as any property claim but repairs are authorised via an approved repairer after an excess has been paid
commercial property claims process: money claims
same as any property claim but require:
- proof that money were on the premises
- details of the occurrence
- confirmation that the matter has been reported to the authorities.
Commercial pecuniary claims: legal expenses
The insured should notify their insurers before legal action commences so the insurer can take any steps they deem appropriate (appointing their own solicitors etc).
Commercial pecuniary claims: Business Interruption
- check the material damage proviso
- insurers may participate in the claim to help minimise the loss.
Indemnity period of business interruption insurance
12-36 months
Creditors Insurance
provides protection to the policyholder in the event that they are unable to repay a loan due to their death, disability or losing their job.
At the proposal stage of business insurance, what questions are asked about how the proposer will react in the event of a claim?
- have they got alternative premise
- how soon can they get up and running
- is there a detailed disaster recovery plan
Commercial pecuniary claims: Creditors Insurance
the insurer will require:
- proof the insured is not working
- evidence of the payments that the insured needs to make
Employers liability compulsory insurance act 1969
compulsory for cover for indemnity against injury or disease by the insureds employees arising out of and in the course of their employment.
Which liability insurances are on a losses-occurring basis
public and employers (sometimes product)
Which liability insurance are on a claims made basis
professional indemnity (sometimes product)
Commercial pecuniary claims: liability (claims made)
questions should be answered on:
- when was the claim made?
- was it in accordance with the policy terms notified to the insurer?
- did the instance cover exist at that time?
Then a full investigation will be carried out
Commercial pecuniary claims: liability (losses-occuring)
questions should be answered on:
- when did the loss occur?
- did the insurance cover exist at that time?
Then a full investigation will be carried out
Commercial pecuniary claims: liability
- decide if claims made or losses-occurring
- was the work that was carried out within the business description
- provide relevant documentation
- interview witnesses
MOJ/Claims portal
processes all injury claims including employers and public liability claims up to 25k.
inc. vulnerable road road users who can’t use the OIC
