Insurance Claims

Resumen

A policy is only a promise until something goes wrong. The claim is the moment that promise is tested: the shop burns, the lorry overturns, the warehouse is broken into, and the insured turns to the insurer and says, in effect, now keep your word. How that request is made, checked and paid is the claims process, and it is where insurance either earns its reputation or loses it.

In this lesson you will follow a claim from the first phone call to the final cheque: what the insured must do, what the insurer must do in reply, and the two very different experts who may be called in to value the loss. You will learn why some claims are paid in full, why others are cut down, and why a few are turned away completely. Get this topic right and you understand how the whole promise of insurance is actually delivered.

Objetivos

  1. Describe the claim procedure from notification of loss to final settlement
  2. State the duties of the insured when a loss occurs
  3. State the duties of the underwriter in handling a claim
  4. Distinguish the roles of the loss assessor and the loss adjuster
  5. Explain the grounds on which an insurer may repudiate a claim

Nota de la lección

Musa runs a provisions store in Kano. One night a wiring fault sets the shop alight and destroys most of his stock. He has a fire policy, so he assumes a cheque is simply on its way. Instead a stranger arrives to inspect the ruins, he is handed a form to fill, and he is asked for receipts he never kept. Weeks pass before any money moves. None of this is the insurer being difficult. It is the claims process working exactly as it should: a series of steps that protects the honest insured, the honest insurer, and every other policyholder whose premiums sit in the same pool. Learn the steps and the duties, and nothing in a claim will surprise you.

Evaluación de la lección

Felicitaciones por completar la lección del Insurance Claims. Ahora que has explorado el conceptos e ideas clave, es hora de poner a prueba tus conocimientos. Esta sección ofrece una variedad de prácticas Preguntas diseñadas para reforzar su comprensión y ayudarle a evaluar su comprensión del material.

Te encontrarás con una variedad de tipos de preguntas, incluyendo preguntas de opción múltiple, preguntas de respuesta corta y preguntas de ensayo. Cada pregunta está cuidadosamente diseñada para evaluar diferentes aspectos de tu conocimiento y habilidades de pensamiento crítico.

Utiliza esta sección de evaluación como una oportunidad para reforzar tu comprensión del tema e identificar cualquier área en la que puedas necesitar un estudio adicional. No te desanimes por los desafíos que encuentres; en su lugar, míralos como oportunidades para el crecimiento y la mejora.

  1. Which of the following is the FIRST step in the claims procedure? A. Completion of the claim form B. Notification of the loss to the insurer C. Appointment of a loss adjuster D. Signing of the discharge voucher Answer: B
  2. A loss adjuster is appointed and paid by the: A. Insured B. Insurer C. Government D. Loss assessor Answer: B
  3. The document signed by the insured to accept a settlement and release the insurer from further liability is the: A. Claim form B. Cover note C. Discharge voucher D. Proposal form Answer: C
  4. An insurer's assessed loss is 4,000,000 naira on a fully insured property with an excess of 250,000 naira. How much will the insurer pay? A. 4,000,000 naira B. 4,250,000 naira C. 3,750,000 naira D. 250,000 naira Answer: C
  5. An insurer may rightly repudiate a claim where the: A. Insured notified the loss promptly B. Loss was caused by a peril the policy excludes C. Property was fully insured D. Insured completed the claim form truthfully Answer: B

Libros Recomendados

Principles of Risk Management and Insurance
Principles of Risk Management and Insurance
Subtítulo: Thirteenth edition
Editorial: Pearson
Año: 2016
ISBN: 978-0-13-408257-8
Descripción: The standard introduction to risk and insurance, covering risk management, insurer operations and the main lines of life, health, property and liability cover.
Fundamentals of Risk and Insurance
Fundamentals of Risk and Insurance
Subtítulo: Tenth edition
Editorial: Wiley
Año: 2008
ISBN: 978-0-470-08753-4
Descripción: A clear account of the nature of risk and the economics of insurance, written for beginning students across life, health, property and liability insurance.
Fundamentals of Insurance
Fundamentals of Insurance
Subtítulo: Second edition
Editorial: Himalaya Publishing House
Año: 2017
ISBN: 978-93-5097-079-9
Descripción: An accessible treatment of insurance in four parts: the basics of risk, insurance management, life insurance and non-life insurance.

Preguntas Anteriores

¿Te preguntas cómo son las preguntas anteriores sobre este tema? Aquí tienes una serie de preguntas sobre Insurance Claims de años anteriores.

WAEC SSCE - Insurance - 2016

Pregunta 1 Informe

PETER CITUKWU'S MOTOR INSURANCE CLAIM Mr. Peter Chukwu owns a Peugeot 406 saloon car which he insured for a value of #2,000,000.00 with Integrity Insurance Plc on comprehensive basis. He uses this vehicle for social, domestic, pleasure purposes and in connection with his business but not for hire and reward. One day, as he was going to the beach with his two children, Emeka and Pauline, he got involved in an accident with another car, a Honda Accord belonging to Mr. Bayo Samuel. Mr. Bayo Samuel was descending a hill at a high speed and consequently hit the back side of Mr. Peter Chukwu's cat damaging the rear bumper, two rear lights and the booth. An argument ensued between Mr. Peter Chukwu and Mr. Bayo Samuel as to how to settle the issue. It was however discovered that Mr. Bayo Samuel had a third party motor insurance cover with Adequate Insurance Company Limited. The accident was reported to Integrity Insurance Plc by Mr. Peter Chukwu who subsequently submitted estimate of repairs, in the sum of two hundred and fifth thousand naira (N250,000.00). The insurer of Mr. Peter Chukwu admitted liability and paid the sum of one hundred and eighty thousand naira (#180,000.00) after adjustment and wrote to Adequate Insurance Company Limited for recovery of its outlay. Mr. Peter Chukwu took delivery of the damaged bumper and rear lights from his mechanic after fixing his car and took them home with the intention of repairing them for sale.

Required:

(a) Identify the principle involved in the case and why?

(b) Explain the principle identified.

(c) Who should take the delivery of the damaged parts of the Peugeot 406 car?

(d) Explain two covers available under the insurance policy held by Mr. Peter Chukwu 
 

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