First Notice of Loss
A: An intermediary.
Q: Who is the broker or agent, who helps connect the insured with the insurer?
(See page 5-4 of the textbook).
A: A party outside the contract who claims the insured is liable for her loss.
Q: Who is a third-party?
(See page 5-4 of the textbook)
A: The purpose of an investigation.
Q: What is to confirm, evidence and document relevant facts so as to assess coverage under the policy and make better claim decisions.
(See page 6-3 of the textbook).
A: This should be written in the first-person narrative.
Q: What is the insured / claimant / witness statement?
(See page 6-11 of the textbook).
A: Loss Mitigation
Q: What is a policy obligation of the insured?
The insured should do everything possible to reduce the loss, since courts won’t support claims for avoidable damage.
(See page 5-13 of the textbook).
A: Ways an insured can report a claim.
Q: What are: in-person to the agent or broker, online forms, chatbots, the insurance company directly, smartphone app, by telephone, by email, etc.
(See page 5-5 of the textbook).
A: Refers to tangible objects.
Q: What is physical evidence?
(See page 6-14 of the textbook).
A: A non-waiver form.
Q: What is a form that notifies the insured of a coverage concern and also states that the insurer reserves the right to deny a claim for other reasons that may only become apparent later in the investigation. It must be signed by the insured to give it legal effect.
(See page 6-5 of the textbook).
A: Examples of supporting services.
Q: What are appraisers, estimators, engineers, body shops, police, lawyer, health providers, restoration contractors, witnesses, etc.
(See page 5-6 of the textbook).
A: Actions an insurer may take upon receiving notice of a material change to risk insured.
Q: What are:
- Accept the changes
- Advise the insured of a change in premium
- Decline to insure the risk
(See page 5-14 of the textbook).
A: Spoilation
Q: What is the intentional alteration or destruction of evidence relevant to legal proceeding.
(See page 6-17 of the textbook).
A: The elements of investigation.
Q: What are:
- Consider legal obligations (e.g., POL requirement)
- The magnitude of the loss (cost v. benefit)
- The tasks required (what does/doesn't need to be done)
- Efficiency (in-person v. telephone v. email)
- Privacy laws (PIPA, PIPEDA, authorization)
- Safety (OH&S)
- Fraud (any red flags?)
(See pages 6-3 and 6-4 of the textbook).
Q: What are:
- Convey a realistic timeline.
- Notify of any coverage issues right away.
- Notify of any applicable deductible.
- Explain policy conditions and limitations where relevant.
- Send a summary and continue to keep the insured informed.
(See pages 5-9 and 5-10 of your textbook)
A: These are set out in the provincial or territorial statutes.
Q: What are the statutory conditions in the common law provinces / territories and the general conditions in Quebec?
(See page 5-11 of the textbook).
A: Reasons why statements are retained in claim files.
Q: What are:
- To provide record of an accident / claim
- To preserve facts
- To refresh a party's memory later, if needed
- May be required as evidence in a judicial setting
- So that others can read and decide on issues at hand
(See pages 6-11 and 6-12 of the textbook).
A: A reservation of rights letter.
Q: What is a unilateral assertion by the insurer that it is preserving its options and waiving none of its rights.
A: The seven (7) basic next steps, after an FNOL is received.
Q: What are:
(See page 5-4 of the textbook).
A: The policy obligations of the insured.
What are:
- Mitigate the loss
- Give details of the loss (what happened)
- Submit a proof of loss (if requested)
- Disclose any other policies in effect (poss contribution)
- Cooperate with the insurer (duh)
- Notice to Police (in cases of poss criminal activity)
- Provide details in writing upon request
- Notify insurer of any material changes during the policy period
- Disclose all known material facts
(See pages 5-11 to 5-15 of the textbook).
A: A model interview approach.
- Introduce yourself
- Ask open-ended questions
- Listen patiently
- Clarify responses
- Maintain a comfortable pace
- Maintain your composure
- Show sensitivity
- Document everything!
(See page 6-10 of the textbook).
A:
(a) continued investigation of the claim after it becomes known that coverage is questionable
(b) silence or inaction on the part of the insurer in response to a request by the insured to confirm that coverage in fact is in place
(c) defending the action against the insured
(d) making payments to third parties on behalf of the insured
(e) conducting settlement negotiations with the claimant or his solicitor
(f) an express or implied representation by an insurer, its adjuster, agent or counsel that coverage will be afforded
(g) attending at mediations, discovery, arbitration and trial
(h) invoking policy provisions – for example, appraisal, exercising the right to repair.
Q: What are ways that an insurance company's conduct may establish an estoppel.