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 GP report (or Subject Access Report) is obtained from the applicant's own doctor by the insurer. Under the Access to Medical Reports Act 1988, the insurer must obtain the applicant's written consent before requesting the report. The applicant also has the right to see the report before it is sent to the insurer and to request corrections.

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

Non-disclosure occurs when an applicant fails to provide material information that would have influenced the insurer's decision to accept the risk or the terms offered. Under the Consumer Insurance Act 2012, non-disclosure is treated as a misrepresentation, and the remedy depends on whether it was deliberate/reckless or merely careless.

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

A loading (or rated premium) means the insurer charges a higher premium than the standard rate because the applicant presents a greater risk than average. This could be due to medical history, hazardous occupation, dangerous hobbies, or other risk factors. The percentage loading reflects the degree of additional risk assessed by the underwriter.

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 death certificate is the primary document required to validate a life insurance death claim. If the death is subject to a coroner's investigation, an interim death certificate may be accepted. The insurer will also require the original policy document (or a declaration if lost), proof of the claimant's identity, and completed claim forms.

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

The Financial Ombudsman Service provides free, independent dispute resolution for consumers who are dissatisfied with how their insurer has handled a complaint or claim. If the insurer's internal complaints process does not resolve the issue, the policyholder can refer the matter to FOS, which can make binding decisions on the insurer up to specified financial limits.

CII R05 Practice Test

CII R05 Practice Test

CII R05 Underwriting and Claims 2