Claims Management and Handling Flashcards
7 cards from real RIBO practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Claims Management and Handling flashcards as text
Which of the following best describes 'bad faith' in insurance claims handling?
Answer: Unreasonable delay, denial without proper investigation, or dishonest dealing in the claims process
Bad faith occurs when an insurer unreasonably or dishonestly fails to meet its obligations, such as denying valid claims without investigation or creating unnecessary delays.
What is the broker's duty when a client's insurance claim is denied by the insurer?
Answer: Advise the client of their rights to dispute or appeal the denial and assist them wherever possible
The broker must inform the client of the denial, explain their options including the right to dispute or seek legal counsel, and continue to act in the client's best interests.
In Ontario property insurance, what is the 'appraisal' process used for?
Answer: Resolving disputes between the insurer and insured regarding the dollar amount of a covered loss
The appraisal process, prescribed in the Ontario Insurance Act's Statutory Conditions, provides a structured mechanism for resolving disagreements about the value of a loss when parties cannot agree.
What is 'waiver' in the context of insurance claims?
Answer: The voluntary abandonment of a known legal right available under the insurance contract
Waiver occurs when an insurer voluntarily and knowingly gives up a legal right it could assert under the policy, such as the right to deny a claim for a policy breach.
What is 'estoppel' as it applies to insurance claims in Ontario?
Answer: A legal principle preventing a party from asserting a right when their prior conduct led the other party to rely on a contrary belief
Estoppel prevents a party from taking a legal position that contradicts their prior conduct when the other party has reasonably relied on that conduct to their detriment.
What are the 'Statutory Conditions' in an Ontario property insurance policy?
Answer: Mandatory conditions prescribed by the Ontario Insurance Act that automatically form part of every property insurance contract
The Ontario Insurance Act's Statutory Conditions are legislatively mandated terms—covering matters such as misrepresentation, cancellation, and proof of loss—that are automatically incorporated into every property insurance policy.
Which of the following best describes 'proximate cause' in insurance claims?
Answer: The dominant or most direct cause that initiates the chain of events leading to a covered loss
Proximate cause is the active, dominant cause that sets a chain of events in motion leading to the loss—insurers use this concept to determine whether a loss falls within policy coverage.