A reinstatement policy could end up bettering the indemnity to the insured or it could end up with the insured acting negligent in carrying out the own repairs. To avoid the pitfalls of these policies then the insurers create specific wording to justify their settlement while avoiding betterment and negligence. A typical Reinstatement policy will apply to: Property that is lost or destroyed – which should be rebuilt or replace by similar property Property that is damaged – the damaged proportion should be repaired and restored. Under such policies there is the possibility of betterment. Howe ..read more

With respect to the information gathered upon investigation of a claim, here is an example of a CII answer under the M85 Module for what information would be required at the capturing of a claim for a handler to carry out appropriate investigations. Example Question. In a claims management system for a motor insurers – what information is necessary upon the capturing of a claim? How does an efficient claims management system help with this? Under a motor insurance policy there are various essential items to capture and as the insured is reporting the accident – the insured will be the entry po ..read more

The coronavirus nightmare appears to have no end in sight as insurers are assailed by huge claims and locked in damaging legal fights with customers. In particular Business Interruption has been a contentious issue between insurer and policyholder with the addition of court costs looming. As the USA attempts to tame the virus and case counts spike elsewhere in the world there is a wave of fundraising from insurers looking for investment. Munich Re ditched a share buyback programme recently, partly to ensure financial firepower to back new business at higher prices. Bermuda based insurer Third ..read more

The legal doctrine of ex turpi causa is one which states that a claim will not succeed if it arises in connection to the claimant’s own illegal act. The purpose of this law is for the courts to refuse a party benefiting from engaging in a serious unlawful act. An appropriate example is the case of Dalvinder Gujra v (1) Balbir Roath (2) Shakti Roath [2018] EWHC 854 (QB), the claimant’s case was that the defendants had agreed to pay him £500 to set fire to two of their motorcars and had further agreed that if he was arrested that they would ensure that charges would not be pursued. In accor ..read more

The statutory definition of fraud as a criminal offence appears in the Fraud Act 2006. There are three types of fraud: Fraud by false representation Fraud by failing to disclose information Fraud by abuse of position The act specifies that those found guilty man either be liable to a fine or imprisonment. The act replaced much of the Theft Act 1978 which is now largely moribund. The Fraudulent Claims Rule: The right of the insurer to forfeit the entire claim was upheld in VERSLOOT DREDGING BV v HDI GERLING (2016) with respect to an entirely fraudulent claim and the exaggeration of an otherwi ..read more

BIRMINGHAM Officers raided a home in Bordesley Green, Birmingham at around 7am. They arrested someone on suspicion of fraud and dangerous driving. It is believed to be an organised crime group behind dozens of deliberate collisions between Nov 2018 – March 2019. Three other men were also arrested and have been released under investigation. Several vehicles were believed to have been involved and they have all now been seized by police. The group is thought to have made up to £100,000.00 in bogus claims after staging the incidents. Detective Inspector Kerrie Martin from the force’s Economic Cri ..read more

I have always been passionate about fraud, as for me it’s the most interesting area of my expertise. For me, fraud represents a threat to our institutions and the impact along with financial impacts, can also create a cultural impact. If fraud is rampant then consumers will view fraud as a victimless crime, that everyone does. Trust in the integrity of the establishment is jeopardized. I personally have a strong sense of justice and for me, fraud is something I am passionate about defeating. Fraud works outside of a handler’s normal field of vision. Subverting the normal checks and balances so ..read more

Without Prejudice is an expression used by lawyers and claims handlers regularly. It is not uncommon to see it used in the wrong context or used when it should not be used. Without Prejudice is a term used in common law and a form of legal privilege with aims of enabling parties to negotiate freely. When there is an existing dispute then without prejudice discussions (off the record so to speak) can be used to establish a resolution. You may see use of the expressions WITHOUT PREJUDICE SAVE AS TO COSTS which means that correspondence can be disclosed in the courts at the end of a trial (and on ..read more

Source: DAC Beachcroft The impact of the 2020 Lockdown which started in March expects to see a lot of business cease trading and become dissolved. Where employees of a business are made redundant; the proportion of accidents in which they are involved and give rise to personal injury claims usually increase. Some employees will face financial pressure and lose their sense of loyalty to a firm. The Third Party (Rights Against Insurers) Act 2010 enables claimants whose personal injury claim would be against a dissolved party, to pursue the insurer on risk at the time of the accident (and thus be ..read more