INSU07018 2022 Practice of Claims and Loss Adjusting 1 (Theory)
The module focuses on the function of insurance claims and the environment in which this function takes place. It examines the progression of a claim from notification to investigation to settlement and dispute resolution with particular reference to the professionals, regulation and documentation involved. It revisits the insurance principles but examines them from the perspective of their role in the claims process. The issues relating to third party claims (e.g. the Personal Injuries Assessment Board and the involvement of the courts.) are given special consideration.
Learning Outcomes
On completion of this module the learner will/should be able to;
Demonstrate a comprehensive knowledge of the claims environment.
Deliberate the progression of a claim from notification to investigation to settlement and dispute resolution with particular reference to the professionals, regulation and documentation involved.
Demonstrate critical knowledge of how indemnity is applied and measured.
Demonstrate a critical knowledge of the special considerations relevant to third party claims.
Teaching and Learning Strategies
Textbook
Dedicated Textbooks for each module in hard copy and downloadable format updated annually to reflect changes in legislation and regulation. Summaries of each chapter will be provided highlighting key topic areas.
How-To Guides
A range of ‘how to’ guides including a glossary of terminology in Insurance and exam support
Synchronous and Asynchronous Lectures
Online lectures utilise lecture notes with extra reading material. Links from tutorials to textbooks for easy access and review In these sessions.
In-class discussion
The in-class discussion will be used to encourage conversation and debate and to support students to build their networks and apply their learning in their workplace.
Quitch - Gamification App
A gamification app to allow students to test their knowledge on each chapter of the textbook.
Online Resources
Infographics, videos, and podcasts, Mock Exams and Questions
Module Assessment Strategies
This module will be assessed by an online MCQ exam contributing 10% of the grade and a final written examination contributing 90% of the final grade.
Repeat Assessments
Learners will repeat the failed element of their assessment or both should that be necessary. The repeat assessment will be an online MCQ exam contributing 10% of the grade and a final written examination contributing 90% of final grade.
Indicative Syllabus
LO1 THE CLAIMS ENVIRONMENT
- Outline the importance of effective claims handling procedures, the main stages in the development of a claim and the important elements of the claims process.
- Explain the differences between first party claims and third party claims.
- Demonstrate the effect of data protection legislation and the Central Bank Consumer Protection Code (CPC) on the claims function.
- Explain how insurance fraud arises and the measures used to prevent, detect and combat fraud.
LO2 CLAIMS NOTIFICATION
- Explain the typical claims notification process, including the information gathered by insurers and why this information is important.
- Explain the duties of the insured after a loss.
- Outline how policyholders and insurers can mitigate the effects of a loss.
- Describe the claims documentation that an insurer may require to support a claim and outline the role of intermediaries in claims notification.
- Explain the importance and uses of claims reserves and describe the reserving process.
LO2 CLAIMS VERIFICATION
- Describe the initial checks that insurers undertake to validate a claim and how the policy structure is used during this process, and demonstrate how the basis of cover can affect a claim.
- Explain the legal principles of insurable interest and utmost good faith and demonstrate their relevance to the handling of claims.
- Explain the legal principle of proximate cause and demonstrate its relevance to the handling of claims.
LO2 CLAIMS INVESTIGATION
- Explain the purpose of claims investigation, including the role of the claims handler and the scope of desktop claims handling.
- Explain the role of loss adjusters, loss assessors, claims investigators, brokers and other professionals involved in claims investigations, including the potential outcomes of an investigation.
LO2 CLAIMS SETTLEMENT
- Explain the ways that insurers settle first party and third party claims.
- Explain and apply the principles of salvage, abandonment, subrogation and contribution.
- Outline the impact of reinsurance recoveries in the claims process.
- Describe the role of the Financial Services Ombudsman (FSO), and the processes of arbitration and mediation in dispute resolution.
LO3 INDEMNITY: HOW MUCH WILL THE POLICY PAY:
- Explain the principle of indemnity and demonstrate the factors that limit and extend the operation of this principle.
- Apply the principle of indemnity to the main classes of general insurance.
LO4 THIRD PARTY CLAIMS - LEGAL CONSIDERATIONS
- Outline the legal basis of a third party claim and the available remedies in tort.
- Explain the main considerations when assessing the quantum of a personal injury claim.
- Demonstrate the role of the Personal Injuries Assessment Board (PIAB).
- Describe the defences in tort and explain the other issues that may reduce the cost of a third party claim.
- Outline the role of the Irish courts system in the claims process including civil and court procedure, and demonstrate the impact of statutory limitation periods on liability claims.
Coursework & Assessment Breakdown
Coursework Assessment
Title | Type | Form | Percent | Week | Learning Outcomes Assessed | |
---|---|---|---|---|---|---|
1 | MCQ | Coursework Assessment | Closed Book Exam | 10 % | Week 9 | 1,2,3 |
End of Semester / Year Assessment
Title | Type | Form | Percent | Week | Learning Outcomes Assessed | |
---|---|---|---|---|---|---|
1 | Final Examination | Final Exam | Closed Book Exam | 90 % | End of Semester | 1,2,3,4 |
Full Time Mode Workload
Type | Location | Description | Hours | Frequency | Avg Workload |
---|---|---|---|---|---|
Lecture | Online | On-line lecture | 1 | Weekly | 1.00 |
Tutorial | Online | Tutorial | 1 | Weekly | 1.00 |
Lecture | Offsite Facility | Face to face class | 3 | Twice Per Semester | 0.40 |
Independent Learning | Not Specified | Independent Learning | 2 | Weekly | 2.00 |
Required & Recommended Book List
Practice of Claims and Loss Adjusting Textbook Insurance Institute of Ireland
Module Resources
European journal of risk regulation
Geneva risk and insurance review
Geneva papers on risk and insurance - issues and practice
Journal of financial services professionals
Journal of insurance issues
Journal of insurance regulation
Journal of risk research
Journal of risk and insurance
Journal of risk and uncertainty
Risk management and insurance review
Risk analysis: an international journal
Insurance Institute of Ireland www.iii.ie
Insurance Ireland Fact File www.insuranceireland.eu
Central Bank of Ireland (Minimum Competency Code) www.centralbank.ie
Central Bank of Ireland – Quarterly Bulletins & Publications www.centralbank.ie
European Insurance and Occupational Pensions Authority www.eiopa.europa.eu/
Central Statistics Office www.cso.ie
Irish Broker Magazine www.irishbroker.ie
The Irish Times
Financial Times
Economist