A liability insurance policy that is triggered at the time a claim is paid, rather than at the time a claim is first reported (claims-made policy) or at the time the injury or damage occurs (occurrence policy). This approach can offer significant benefits in terms of pricing accuracy. However, since claims will be paid only while the policy remains active, the insured facing a claim cannot cancel the policy while the claim is pending, often for years, unless he or she is willing to pay the claim out of personal assets.
Insurance Encyclopedia
Claims-related method
A method of dividing the cost of insurance purchased for the organisation and apportioning it among the cost centres based on claims experience. The aim is to ensure that each part of the company contributes to total insurance costs in a manner reflecting its own claims record. It encourages loss prevention.
Claims-review type of foundation
A type of foundation that provides peer review by physicians to the numerous fiscal agents or carriers involved in its area.
Claims, “Without Prejudice”
In all correspondence with the insured relating to a claim, the Insurers incorporate the words” Without Prejudice” on the top. The effect of these words is that whatever action the insures may take in the processing of the claim, they reserve their right to deny liability ultimately if they are legally entitled to do so.
Claims, Cash Loss Settlement, Motor
Major repairs to a goods vehicle, for example involves a large outlay and the insured may not be able to spend such large amounts initially and then claim reimbursement from the Insurers after the repairs are carried out. In such cases Insurers offer to pay a sum which is lower than the amount of repairs recommended by the surveyors, say, by 25% to 30% without insisting on repairs being carried out. These settlements are also effected when, in the case of a total loss, the salvage is not easily disposable or the salvage value realizable is not reasonable. A mutually agreed salvage value is deducted from the total loss amount recommended by the Surveyor and the net amounts paid, the insured being allowed to retain the salvage.Claims, Cash Payment : When the Insurers are satisfied in regard to the cause and extent of loss, as ascertained from the claim form and other inquiries and also, in large losses, report from independent surveyors, the loss is settled by cash payment. This is the most common method of claims settlement.Claims, Reinstatement : This method would apply in respect of buildings or other property destroyed or damaged by Fire. This method is rarely used by the Insurers, because once this method is chosen by Insurers, they cannot subsequently withdraw and offer cash settlement. Under this method, the responsibility for the way in which reinstatement is carried out will be of the Insurers. Generally, Insurers would resort to this method only when the insured claims an amount far in excess of the cost of reinstatement.Claims, Repair : Instead of making a cash payment, the settlements of claims may be effected by repair. This is the practice followed for motor damage claims. The procedure is for the insured to submit a detailed estimate of the cost of repairs to the Insurers who will arrange an inspection of the damaged vehicle to see that the repairs are necessary and the cost reasonable. Thereafter, the Insurers will authorize the repair of the vehicle. On receipt of the final bill of repairs and a satisfaction note from the insured, the repairer is paid.Claims, Replacement : he Insurers may Directly arrange with a dealer to replace the property (e.g., jewellery) lost or damaged. This method is commonly employed under plate glass Insurance.Claims, Theft Claims, Vehicles : If the vehicle is stolen and not traced by the police, say, even after 4 to 5 months, the loss is considered on a total loss basis.Claims, Total Loss, Accidental Damage, Motor : If, in the opinion of the Surveyor, a vehicle is not repairable or the repairs are not economical, the loss is settled on a total loss basis. The amount payable is the actual market value of the vehicle immediately prior to the loss or the insured value of the vehicle, whichever is the less. The salvage that is, whatever remains of the damaged vehicle, is taken over by the Insurers and disposed of for their own benefit.Claims Notified/Reported : Claims that have been incurred and which have been notified or reported to the insurer. It is often used in relation to those claims reported during the accounting period.
Claims, Methods of Indemnification
There are several methods of providing indemnity to the insured. These are:
Clash Cover
A casualty excess of loss reinsurance agreement with a retention level equal to or higher than the maximum limits written under any one reinsured policy or contract reinsured under the reinsurance agreement. Usually applicable to casualty lines of business, the clash cover is intended to protect the ceding company against accumulations of loss arising from multiple insureds and/or multiple lines of business for one insured involved in one loss occurrence. Clash cover may also be provided for single policy exposure based on ECO/XPL and run away defense costs. Sometimes referred to as Unknown Accumulation Cover.
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A type of catastrophe reinsurance for casualty insurance. The retention is equal to the highest limit of any one insurance policy covered by the agreement. Clash cover is written to cover all losses from one source, such as a construction site. More than one insured may be involved in the same occurrence, known as a clash.
Clash cover/contingency cover
An excess of loss treaty with a retention higher than the limits on any one reinsured policy or contract. The agreement covers the reinsured’s exposure to multiple retentions when two or more policies (perhaps from different lines of business) are involved in the same occurrence in an amount that exceeds the clash cover retention.
Class
UK: a category of insurance business, as set out for regulatory purposes in Schedules 1 (general business) and 2 (long term business) to the Regulated Activities Order (Contracts of Insurance).
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A group of policyholders who have the same characteristics and are grouped together to be rated.
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Group of insureds who have similar exposures and experience and are grouped together for rating purposes.
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MEDICAL,USA: Groups or categories of individuals with similar characteristics and risks for the purpose of setting insurance rates or to determine the amount of coverage for which a person is eligible under an insurance policy.
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The Underwriting or rating group into which a particular risk must be placed. Pertains to type of business, location, and other factors. Classifying persons, property or operations as a basis for tabulating statistical experience and determining premium rates. The individual class. The hazards of operating an automobile vary with respect to the type of car and the purposes for which it is used. Therefore, automobile Insurance groups private passenger cars. trucks, taxi cabs and automobiles operated by garages in different classifications to determine premium rates.
Class A member
Any pension scheme member who is not a Class B or Class C member. Class A embraces members of schemes established on or after 14 March 1989 and all new members of earlier schemes joining on or after 1 June 1989. The maximum retirement benefit for Class A on retiring between ages 50 and 75 is two-thirds of final remuneration. The earnings cap applies. The tax-free lump sum on retirement is 3/80ths of final salary for each year of service (not exceeding 40 years) or, if greater, 2.25 times the annual pension.