Valid Claims And Claims Settlement Flashcards
When two insurance policies cover the same risk and they both contain a contribution condition, how would a claim usually be settled?
Both policies would contribute a proportionate amount.
Under the standard fire insurance policy, the pro rata condition of average requires the sum insured, at the date of loss, to be what minimum percentage of the value at risk to obtain full settlement?
100%
A consumer used the services of an intermediary to effect a household insurance policy. In the event of a claim, who is legally responsible for proving the amount of the loss?
The consumer in all cases
What settlement method would normally be used for a valid claim under a business interruption
Payment of money
When a motor insurer takes advantage of contribution rights, from whom can some of its claims settlement costs be recovered?
Another insurer
A specialist motor insurer has recently experienced a high level of fraudulent claims. Which of its policyholders could suffer as a result of this fraud?
All PH
Application of the arbitration clause might occur under a fire insurance policy as a result of a dispute between the insurer and the insured regarding the
Amount of this claim
An insured is subject to implied duties when
Submitting a claim.under insurance policy
Upon becoming aware that a fraudulent claim has been made, what is the earliest point from which an insurer may terminate the insurance policy?
Inception of policy
When is an amount initially reserved in the claims process?
Claim is notified
Why would an insurer register claim details on MIAFTR2?
To help prevent fraud
Which insurance policy condition can an insurer invoke to recover all of its outlay in respect of a claim?
Subrogation
The purpose of the Claims and Underwriting Exchange is to
Hello detect fraud claims
Under an employers’ liability insurance policy, delays often occur between a claim being notified and final settlement. To ensure adequate funds are available to ultimately pay the claim, an insurer will rely on
Reserving
An insurer can terminate an insurance policy without refunding premiums if the policyholder
Fraud claims
The insured has many duties after uninsured loss occurs in connection with property insurance what are some examples
At the insured expense provide all information and assistance to the insurer. Notify the insurer as soon as possible. Take reasonable steps to minimise the loss. Where appropriate notify the police as soon as possible
What is the formula for contribution
Sun insured divide total sum insured = insuers liability
What is the formula for average
Sum insured Devide value at risk = claim payment
When might the average condition apply
In the event of under insurance like property
Who is eligible to claim compensation from the motor insurance bureau
Pedestrians injured by vehicles which failed to stop and I never traced. Hit and run cases
What rights does the insurance act 2015 give an insurer when it receives a claim that turns out to be fraudulent ?
Reject the claim. Recover any payments from the insured it has already made in respect of that claim. Refuse all claims made after the fraud claim. Give notice to the insured that the insurance contract is terminated from the time of the fraud claim. Retained the premium at its discretion if the contract is terminated
What is meant by onus of proof
It is the expression used to describe the duty imposed on an individual to produce evidence to prove what has been stated or affirmed is true
What does the insured have to prove when making a claim
That an insured peril arose. The financial amount of the loss
What facts must an insurer check when establishing whether a claim is valid
The cover was in force at the time of the loss. The insured is named in a policy. The peril is covered. Reasonable steps to minimise the loss. Conditions and warranties have been complied with. The principle of utmost good faith was originally complied with. No exceptions are appropriate. The value of the loss is reasonable
The main imply duties imposed on the insured on the occurrence of the insuered which might give rise to a claim
Act as though uninsured and try to minimise the loss. Advise the appropriate authorities when necessary. Prevent the loss from spreading. Not hinder the insurer in the event of the claims investigation