A clause in a reinsurance treaty providing for early notice of possible claims and cooperation in the defence of claim that may affect the reinsurer and stipulating that the insurers shall not admit liability for such a claim without the reinsurer’s consent.
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UK: Requires the reinsured to give prompt or immediate notice to the reinsurer on becoming aware of a loss likely to involve the reinsurer. The reinsured must at all times cooperate with the reinsurer in the negotiation and settlement of the loss. In liability claims the reinsured must not admit liability without the reinsurer’s consent.
Tag: RAW
Claims Cooperation Clause, Reinsurance
Refer: “Reinsurance, Claims Cooperation Clause.”
Claims equalisation reserve
An insurer’s reserve for smoothing out fluctuations in claims costs where the incidence is of an uneven nature. Produces a greater level of consistency in the revenue account.
Claims Equalization Reserve
A reserve by an insurance company to smooth the cost of claims which occur at irregular intervals, e.g., through natural phenomena such as exceptionally adverse weather, so as to prevent undue fluctuations in the revenue account.
Claims Equalization Reserves
Funds put aside by Insurers in years of good claims experience which can be used to pay claims in bad years.
Claims examiner
1. In industrial cases, a representative of the insurer who investigates, evaluates, and negotiates the patient’s insurance claim and acts for the company in the settlement of claims. 2. Individual employed by an insurance company who assists in settlement of claims by investigating claims, approving claims that are valid, and denying claims that are invalid or fraudulent. Some claims examiners are individuals who operate independently and are hired by insurance companies to adjust a specific loss. Also called adjuster, claims processor, claims representative, claims administrator, or health insurance adjuster.
Claims Expenses
The expenses of investing and settling claims, e.g., adjusters’ fees as distinct from the claims themselves.
Claims expenses/claims handling expenses
Direct costs of investigation and settlement as distinct from the payments of the claims themselves. Includes loss adjusters’ fees, court fees, etc. The indirect expenses, claims handling expenses, relate to the salaries and overheads associated with running a claims department.
Claims experience
The insured’s claims history with regard to the cost and frequency of previous claims. It is material for an insured to disclose his claims experience when proposing insurance. The term also describes the relationship between premium and claims experienced by an insurer for a particular class of business over a period of time.
Claims Experience Discount/Loading for Fire Insurance
Risks having sum insured (on buildings and contents of all blocks in one compound of one complex in one location) above Rs. 50 crore shall attract claims experience discount/loadings based on the incurred claims experience of all the policies covering the insured’s interest for preceding 36 months excluding the expiring policy period. If there be break available 36 months experience is to be taken into account.