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Insurance > 4.1 Claims: Notifications > Flashcards

4.1 Claims: Notifications Flashcards

1
Q

Decision in Lloyd’s TSB v Lloyd’s Bank

A

proximate cause was poor advice, nor poor training

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2
Q

Two people insured may contact when claim arises

A

Insurer or broker

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3
Q

What basis should all ex gratia payments be made on and why

A

W/o prejudice to avoid disclosure if litigation ensues

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4
Q

What does ‘may’ give rise to a claim mean under Kidson

A

Real + appreciable possibility, on an objective view

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5
Q

What case interpreted the meaning of ‘as soon as practicable’ for notification clauses

A

Kidson

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6
Q

What kind of policy coverage is more expensive and why

A

Occurrence basis, as exposes insurer to indefinite future liability

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7
Q

What are aggregation clauses

A

Aggregates together different losses to create one claim

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8
Q

Kidson on ‘as soon as practicable’ meaning

A

When insured has sufficient knowledge of possibility of claim

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9
Q

Why does 11 IA not apply to notification CPs to liability

A

Notification CPs relate to risk as a whole, not a particular risk

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10
Q

Who will insurer involve first if claim arises

A

Claims handler

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11
Q

What is a claims made policy

A

Insurer at time of claim/notification = liable, even if circumstance turns into claim outside of policy period

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12
Q

Kidson defines ‘may’ or ‘likely’ for circumstances?

A

‘May’

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13
Q

What does ‘likely’ to give rise to a claim mean under Layher

A

At least 50% chance of claim being made, not just possible

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14
Q

What is the general inclination of insurer when claim received

A

To settle

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15
Q

Two cases on wording for circumstance - ‘may’ and ‘likely’

A

Kidson and Layher

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16
Q

What does s.13A IA do

A

Gives insured right to claim damages if insurer fails to settle within reasonable time

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17
Q

What does the difference in decision between Countrywide and Lloyd’s suggest?

A

‘Single act/omission’ cannot be more remote cause of poor training, but ‘single source’ can be

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18
Q

What is an occurrence basis policy

A

Insurer at time of occurrence = liable, regardless of insurer at time of claim

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19
Q

What should insurer do if received notification of claim, but potentially there was a circumstance before claim arose

A

Check no previous notification of the circumstance

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20
Q

What guidelines give minimum standards for S’s PII

A

SRA Minimum Ts&Cs

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21
Q

What case suggested that, for aggregation clauses, ongoing affairs are not a single act

A

Lloyd’s TSB v Lloyd’s Bank

22
Q

Two alternatives to a waiver of rights

A

Ex gratia payment or w/o prejudice payment

23
Q

How does SRA limit exclusions/avoidance under PII for Ss

A

Only allow exclusion for fraudulent party, not for innocent, and cannot avoid in event of fraud

24
Q

What is a w/o prejudice payment

A

Settlement between parties

25
Q

What do policies include if with same insurer for several years

A

Retroactive date - cover all claims back to beginning of first policy

26
Q

Kuwait Airways policy wording

A

Max policy limit for ‘any one occurrence’

27
Q

What Act brought in provisions to control insurer’s late payment of claims

A

Enterprise Act 2016, inserting s.13A IA

28
Q

What two things should S get if potential claim

A

Final policy wording + check Proposal Form for binding Ws

29
Q

When can insured claim damages for insurer’s failure to settle within reasonable time

A

If insured can prove actual loss, and loss contemplated by parties at time of C

30
Q

Layher defines ‘may’ or ‘likely’ for circumstances?

A

‘Likely’

31
Q

Dawson’s Field Arbitration gave what test for aggregation

A

Four unities test - locality, time, cause and intention of human agents

32
Q

Who can PII only be obtained from per SRA

A

‘Participating Insurers’

33
Q

What is the minimum limit for PII per SRA

A

£2/3m

34
Q

Two kinds of policy coverage, relating to what claims are covered

A

Claims made or occurrence basis

35
Q

What should S check the notification relates to

A

Included circumstances

36
Q

Why might insurer deliberately waive rights

A

To preserve goodwill w/ client

37
Q

What happens if failed to comply w/ notification CP to liability

A

Insurer can refuse to pay out

38
Q

Two potential CoIs when acting for insurer + insured

A

Subrogation (BI of insurer may = settling) and acting for both (e.g. insured’s defence on insurer’s instructions)

39
Q

In an aggregation clause, what does insured usually want to argue

A

In favour of aggregation, to avoid paying excess multiple times

40
Q

Can insurer contract out of 13A IA

A

Yes, if complying w/ 16 + 17, and not consumer policy

41
Q

What is an ex gratia payment

A

Denies technical liability whilst preserving goodwill

42
Q

What case adopted the four unities test from Dawson’s Field

A

Kuwait Airways

43
Q

How was Countrywide decided differently to Lloyd’s

A

Poor training WAS a single source

44
Q

When might insurer be in favour of aggregation clause

A

If in insurance tower and losses likely to be sgnificant

45
Q

Lloyd’s TSB v Lloyd’s Bank policy wording

A

Series of 3rd party claims ‘resulting from a single act or omission’ = one claim

46
Q

What ex gratia payment is usually recoverable under reinsurance C

A

W/o prejudice only

47
Q

From when must policy be for s.13A IA to apply

A

04/05/2017

48
Q

How can you avoid waiving rights

A

Expressly reserve rights

49
Q

Three things notification clause usually sets down

A

Timeframe to notify, methods and info to provide

50
Q

Policy wording for Countrywide

A

‘Single source’ = one claim

51
Q

What should insurers do if notification of excluded circumstances

A

Reject notification

52
Q

What was the decision in Kuwait Airways

A

One occurrence was the invasion of Kuwait, leading to the destruction of the 15 planes - one claim

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