INSU07018 2022 Practice of Claims and Loss Adjusting 1 (Theory)

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.

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

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.

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.

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.