6 Handling Personal Lines Claims

Question 0

Questions for claim handlers

Answer 0

Who - is person making claim covered
When - did loss happen during pol period
Where - did it occur in insured location
How - circumstances leading to loss - covered peril¿
What - subject matter of loss¿

Question 1

Personal line claims - types and common features

Answer 1

Personal insurances. Buildings. Household. Contents. Pet. Travel. Typical claims lost camera. Damage to floor due to washing machine leakage. Common 1st party not business claims. Low value high freq claim not be on phone

Question 2

Motor claims - fnol 1st notification of loss

Answer 2

Fnol - key - can make sig diff to probability. Fnol will seek to provide hire vehicle. Will seek that police notified - crime ref no.. Involvement of approved repair garages etc. Gather as much info as poss. Rehab may be offerd to mitigate 3rd p losses

Question 3

Assessing coverage

1st points, check prem has been paid, compare facts of the loss with the cover, and then…..

Answer 3

Does date and time of loss fall in pol period
Has claim been notified as req in pol
Does location of loss fall within geographical limits
Is the person claiming entitled to indemnity
Has insured complied with warranties and conditions
Does anything from uw file conflict with loss

Question 4

Denial of coverage

Answer 4

Possibility of litigation and subject to cpr - civil procedure rules

Question 5

The prelimanary assessment of claims may lead to;

Answer 5

Straightforward rejection for lack of cover
Acceptance of liability subject to confirmation of amount including limits deductibles excesses and the like
Indication that input is needed from loss adjustor or lawyer
Indication of what info is needed from 3rd parties, eg police fire brigrade, weather reports

Question 6

Loss adjustor needed for property claim fire

Claim needs to use the expert opinion for many reasons”

Answer 6

Visit house, investigate facts, what caused fire, identify any point of concern
Liaise with insured, make arrangements for accom
Assess extent of required repairs
Reach initial assessmemt of quantum to set reserve
Gather relevant info such as fire report, witness statement

Question 7

Instructing advisors and experts remember insurers may have a delegated panel advisors,s eg lawyers, loss adjustors, motor repairere, if panel is fixed claims delegation must only be given in exceptional circumstances

Answer 7

Expert witnesses must comply with civil procedures cpr and the protocol for expert evidence.
Coverage lawyer only has duty to insurer
Loss adjustor has duty to cila, so insurer and insured
Expert witness has a statutory overriding duty to court . Single joint expert appointed by court has duty to court and both parties.
Loss adjustors must comply with cila rules
Surveyors ect with their bodied
Claims prof witj reg environment

Question 8

Loss adjustor is the expert most frequently requested from claim handler

Answer 8

May be asked to
Investigate cause of loss, eg find out if fire was caused deliberately if suspicious. Investigate cause of flood claim
Advise on quantum recommend reserve
Liaise with insured
Oversee the repair or rebuilding of property
Negotiate settlement
Any combo  of above
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Question 9

Communicating with the experts, all letters of instruction should have

Answer 9

Identify the policy insured and claimant if appropriate
Give brief details of the claim to be invedtigated or reported on
Clear explanation of the instructions given what is required what is not authorised
Timeline or deadline for reply
Format of any report, such as full written report, short note or email or phone call
Expected basis on which fees will be charged (hourly including expenses, caps

Question 10

Experts for building claims

Answer 10

Surveyors (subsidence claims)
Accountants, forensic accountants, loss of profit bi
Fire investigators

Question 11

Experts for personal inj claims

Answer 11

Doctors - diagnosis / prognosis
Accountants - income loss
Rehabilitación specialists
Lawyers - causation assessment of damages

Question 12

Other info for investigating claims / use of experts

Answer 12

Fire brigrade may provide witness statements, meteorológicas office provide weather reporte, environmental agency flood reports, surveyors

Question 13

Loss adjustor dealing with flood claims, here we would be looking for

Answer 13

Metorological info to confirm flooding occurs in the region, over which exact area, at which depth, and when, from consulting firms or directly on net.
Details of the suppliers of rental accom or mobile homes for alternative accom, x
Details of specialist providers of drying out equip, local trade directories

Question 14

Pairs and sets

Using average

Answer 14

Replace one item only even if part of a set

House insurance - average cant be applied unless an express clause in the policy

Question 15

Limitations and restrictions to policy indemnity

Answer 15

Excesses - insured pays 1st bit( if insured receives cash settlement excess must be deducted)
Franchise - no liab for any amount less than the franchise
Deductibles-large excess typically corporate

Question 16

New for old cover is used because ( related to wear and tear

Answer 16

Because the claim payment is not enough to buy a new table when wear and tear taken into account

Question 17

Agreed value policies, no need to

Answer 17

Obtain proof of stolen item
Estimate and make a deduction for wear and tear or market value
Consider any questions of underinsurance