CII R05 Underwriting and Claims 2

Question 1

What is a 'GP report' (Subject Access Report) in the context of insurance underwriting, and under which legislation is consent required?

Accepted Answer

A report from the applicant's own GP requested by the insurer with the applicant's consent under the Access to Medical Reports Act 1988

Answer

A report prepared by the insurer's own doctor; no consent is needed

Answer

A self-declaration form completed by the applicant without any doctor involvement

Answer

A report from a specialist hospital that is automatically shared with all insurers

Question 2

What is the significance of 'non-disclosure' in relation to a protection insurance claim?

Accepted Answer

It refers to the failure to disclose material information at the application stage which could affect the insurer's decision to accept the risk

Answer

It means the policyholder forgot to pay a premium

Answer

It means the insurer did not disclose the policy terms to the applicant

Answer

It refers to the policyholder's decision to keep the policy confidential from their family

Question 3

An insurer applies a 'loading' to a protection policy. What does this mean?

Accepted Answer

The insurer charges an additional premium above the standard rate to reflect a higher-than-normal risk

Answer

The insurer adds a longer deferred period to the policy

Answer

The insurer reduces the sum assured to compensate for the additional risk

Answer

The insurer adds extra conditions to the policy that are not usually covered

Question 4

In the claims process for a life insurance policy, what is the primary document required to validate a death claim?

Accepted Answer

The death certificate (or coroner's interim certificate if an inquest is pending)

Answer

The policyholder's most recent bank statement

Answer

A letter from the policyholder's employer confirming their absence from work

Answer

The original policy application form only

Question 5

What is the role of the Financial Ombudsman Service (FOS) in relation to protection insurance claims?

Accepted Answer

FOS provides a free, independent dispute resolution service if a policyholder is dissatisfied with the insurer's claim decision

Answer

FOS underwrites all protection policies sold in the UK

Answer

FOS sets the premium rates for all UK insurers

Answer

FOS is responsible for paying claims when an insurer becomes insolvent

Question 6

An insurer applies an 'exclusion' to a protection policy. What effect does this have?

Accepted Answer

It removes cover for a specific condition, activity, or circumstance — no claim will be paid if the excluded event causes the claim

Answer

It increases the sum assured for the excluded condition

Answer

It means the policy will only pay out for the excluded condition

Answer

It delays the start of the policy by 12 months