Chap 2 - Determining Cover

Question 0

Aggregation clause

Answer 0

Dictates how if not all related claims arrising for eg from a single event or cause may be grouped together into a single ‘claim’
Crucial to understand the no. Of excesses payable or for a series of losses whether there is sufficient cover

Question 1

Contra proferentem rule

Answer 1

Provides for ambiguous terms to be construed in the insureds favour.

Question 2

EL - minimum cover

El deductible?

Answer 2

5m per elto 1998

Excess or deductible is prohibited

Question 3

Limit for 3rd party liab motor ins under traffic act

Minimum for 3rd prop damage

Answer 3

Unlimited

1 million

Question 4

Determine existence of cover

Answer 4

1- is claim covered under t and cs
2- 3rd p only is insured liable
3- what is the value of the claim (investigation and reserving)
4- recoveries- recouping outlays from responsible parties

Question 5

Policy may express limits as

Answer 5

Any one loss
Each and every claim
In the agg

Question 6

Typical extensions

Answer 6

Replacement of car keys or house keys (house pol)
Alternative accom (buildings) accidental dam, personal possession cover (buildings)
Health and safety at work, defence costs - el
Cover for temp replacement vehicles - motor

Question 7

Typical exclusions

Answer 7

More specific cover, other insurance, losses not fortuitous, deliberate acts, dishonesty and fraud, criminal fines and penalties, certain perils, circumstances or claims known pre-inception

Question 8

Basis on which classes r written
Occurrence
Claims made

Answer 8

Claims made; product recall, pi (claims made or occurrence; product liability, marine liability

Occurring; prop 1st party, BI, El, PL, personal lines, marine hull, marine cargo, motor

Question 9

Purpose of prompt notification

Answer 9

To provide opportunity to minimise the loss
So insurer can be in position to defend claim properly
To meet court or other deadlines
Preserve subrogation rights

Question 10

Other uses for claims info

Answer 10

Uw feedback, loss reserving, accounting info, ri info, mgmt relations, customer relations, compliance

Question 11

Info needed to verify claim

Answer 11

Name of insured. Pol no or reference
Date time and place of incident
What took place
Description of damage
Statement from insured
Date claim notified