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1 THE CHARTERED INSURANCE INSTITUTE P85 Diploma in Insurance Unit P85 Claims practice October 2012 examination Instructions Two hours are allowed for this paper. Do not begin writing until the invigilator instructs you to. Read the instructions on page 3 carefully before answering any questions. Provide the information requested on the answer book and form B. You are allowed to write on the inside pages of this question paper, but you must NOT write your name, candidate number, PIN or any other identification anywhere on this question paper. The answer book and this question paper must both be handed in personally by you to the invigilator before you leave the examination room. Failure to comply with this regulation will result in your paper not being marked and you may be prevented from entering this examination in the future. 2618

2 P85 October 2012 The Chartered Insurance Institute

3 P85 October 2012 Unit P85 Claims practice Instructions to candidates Read the instructions below before answering any questions Two hours are allowed for this paper, which contains 15 short answer questions and carries a total of 130 marks. Read carefully all questions and information provided before starting to answer. Your answer will be marked strictly in accordance with the question set. The number of marks allocated to each question part is given next to the question and you should spend your time in accordance with that allocation. You may find it helpful in some places to make rough notes in the answer booklet. If you do this, you should cross through these notes before you hand in the booklet. It is important to show each step in any calculation, even if you have used a calculator. If you bring a calculator into the examination room, it must be a silent battery or solar-powered non-programmable calculator. The use of electronic equipment capable of being programmed to hold alphabetic or numerical data and/or formulae is prohibited. You may use a financial or scientific calculator, provided it meets these requirements. Answer each question on a new page. If a question has more than one part, leave six lines blank after each part PTO

4 P85 October 2012 Answer ALL questions Note form is acceptable where this conveys all the necessary information 1. Explain briefly two similarities and two differences for a claims handler in handling first party claims and third party claims. (8) 2. You are a claims handler working for XYZ Insurance Ltd. XYZ Insurance Ltd decide to enter a new market overseas and you will be handling the claims arising from that business. (a) (b) Explain briefly why it is important for you to understand the regulatory environment in that location. Identify an example of an overseas regulatory regime and summarise its key requirements. (3) (3) 3. Explain why it is important for the claims department to communicate with other functions within an insurance company, when setting internal service standards. (8) 4. Define the tort of negligence, citing case law and provide an example of a claim which could be based in negligence. (8) 5. Outline the requirements of the Financial Services Authority s Treating Customers Fairly rules which apply to claims handling. (8) 6. Jackson plc has a liability policy with XYZ plc. The limit of indemnity under the policy is 2,000,000 each and every loss, subject to a 4,000,000 annual aggregate limit. During the policy year, Jackson submits various claims to XYZ plc which are settled in order as below. For each claim, confirm the amount paid by XYZ plc explaining your answer. (a) 1,000,000 (b) 3,100,000 (c) 500,000 (d) 2,000,000 (e) 100,000 (10) 7. Robinson Ltd has an insurance policy which excludes damage caused by flood but covers damage caused by wind. Robinson Ltd submits a large property claim to their insurer after bad weather damages their premises. The insurer investigates and determines that the loss was caused by the combination of wind and flood; and that neither would have caused damage on their own. Explain the legal principles which will apply to Robinson Ltd s claim in this situation, citing case law in support of your answer. (12)

5 P85 October (a) List six potential indicators of a fraudulent claim. (6) (b) Identify two examples of an industry source against which suspected cases of fraud may be checked. (4) 9. Identify three key features of arbitration. (6) 10. Jane submits a claim for her lost camera. The camera cost 500 when new. The claim is covered under the policy. Explain briefly the factors that will determine how the claims handler will calculate the settlement due to Jane. (8) 11. Brown plc receives a Pre-Action Protocol letter relating to a public liability claim from an injured visitor to their premises. They pass the claim to their insurer NEL. NEL investigates and identifies that there may be a potential breach of warranty and reserves their rights against Brown plc. Explain why NEL may need to instruct two separate firms of solicitors in this situation. (10) 12. Identify four examples of claims where the definition of the insured in the policy may be a factor. (8) 13. Joe is a claims handler at MVP Insurance Co. He is handling a personal injury claim involving a businessman who is permanently disabled as a result of an accident. (a) Identify the track under the Civil Procedure Rules to which this case is likely to be allocated and explain briefly the reasons for your answer. (9) (b) Provide three examples of the type of expert evidence which may be obtained by Joe. (3) 14. Explain why a claims handler should be aware of the terms of any reinsurance applicable to a claim that they are handling. (10) 15. Philip telephones his insurer to advise them of a claim relating to stolen personal property. List six questions relating to the claim that the insurer will ask Philip. (6)

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