Making The Claim Flashcards
How can someone other than the PH make a claim? (9)
By assignment By agency Trusts RTA 1988 Third Parties (Rights against Insurers) Act 2010 Law of Property Act 1925 Fires Prevention (Metropolis) Act 1774 Policies with additional insureds Noting the interest of 3rd parties
How does making a claim on a policy under Assignment work?
The contract or the benefit of the contract can be assigned to a 3rd party
If its legal that person can enforce the contract in their own name
If its an equitable assignment the assignee must join the assignor in the action
How does making a claim on a policy under Agency work?
A 3rd party can claim if they have authorised an agent (PH) to insure on their behalf
How does making a claim on a policy under a Trust work?
Most common example is the Married Womens Property Act 1882
Benefits are the money is not considered part of the estate and does not need to be used to clear debts
What is privity of contract?
It confines the rights and duties under a contract to the person who originally made it
How does someone other than the PH make a claim on a policy under The RTA 1988?
Named drivers or someone with the PHs permission can make a claim
Victims can also make a direct claim on the policy
How does someone other than the PH make a claim on a policy under The Third Parties (Rights against Insurers) Act 2010?
If a PH has a liability policy, becomes insolvent but also has a liability claim then their rights under the contract transfer to the 3rd party claimant.
What happens if you sell your building while making a claim make a claim under The Law of Property Act 1925?
If you own a building, sell it and then make a claim you have to hand the money over
How does someone other than the PH make a claim on a policy under The Fire Prevention (Metropolis) Act 1774?
If a building burns down then a person who has legal or equitable interest in it can insist the insurer reinstates the building
Other than notice of loss what else must the PH inform the insurer about in relation to claims?
Must give notice of any event or incident which may give rise to a claim
When can an insurer not reject a claim for breach of a notification or other claim condidtion?
In the compulsory classes of motor and EL
Late reported claims will have to be met but the insurer may hve right of recovery from the insured
In the event of a claim who does the burdon of proof of the loss sit with?
The insured
Must prove the loss was caused by an insured peril and the amount of the loss
Must be established on the balance of proabilities
What type of acts by the insured will result in a rejected claim?
Deliberate acts
Loss must be accidental or fortuitous
Negligence and carelessness are covered
Wnag are the ICOB rules around claims? (4)
Handle claims fairly & promptly
Provide reasonable guidance on how to claim
Not unreasonably reject a claim
Settle claims promptly once a settlement is agreed
What remedies are available to PHs if the insurer is late with payment?
Used to be interest only
The Enterprise Act 2016 added a section to the IA 2015 to allow the courts to award damages for late payment (damages are in addition to the sum due and any interest on those sums)
What are the main problems in relation to Causation?
Sometimes 2 perils (1 covered & 1 excluded) are linked and difficult to seperate
One peril could cause another - what if one is excluded?
What does the MIA 1906 say anout causation?
Insurer is liable for any loss proximately caused by an insured peril
Not liable for any loss not proximately caused by an insured peril
What are the basis that an insurer can write a policy?
Specified or named perils basis
All Risks basis
Before the Leyland Shipping case what was considered to be the proximate cause in a loss?
The latest event in the chain, proximate in time, was the cause of the loss.
Now its proximate efficiency - determined by common sense
What happens if there is one insured and one uninsured event and we cant establish which was the proximate cause?
The insured event wins and its deemed the loss was caused by an insured event
What happens if there is one insured and one excluded event and we cant establish which was the proximate cause?
The exluded event wins and the insurer can reject liability
What happens if there is one insured and one uninsured event, they combined to cause a loss, neither would have caused a loss on its own?
Full liability for the loss and insured peril prevails
Who has the burdon of proof that the insured peril was the proximate cause?
The insured
However on an all risk policy the PH need only prove that the loss was accidental
Once proven by the insured, the insurer then has to prove otherwise if they want to reject the claim
Can an insurer exclude some risks e.g. war absolutly?
Yes
Can rejrct claims where war is a remote cause
“Losses caused directly or indirectly” clause
