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U N D E R W R I T E R M A N U A L
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DETAILED TABLE OF CONTENTS
About the Underwiter Manual and Companion ................................................................ 2
1 Marketing And Advertising ................................................................................ 4
2 Planning And Product Development ................................................................ 4
3 Retail Vs Wholesale Clients ............................................................................... 5
3.1 Retail Clients ........................................................................................................ 5
3.2 Wholesale Clients ................................................................................................. 5
3.3 Bundled Covers .................................................................................................... 6
3.4 Relevance Of Retail / Wholesale Distinction ......................................................... 6
4 Contact With Brokers And Insureds ................................................................. 7
5 Can You Underwrite The Business? ................................................................. 7
6 Service Standards .............................................................................................. 8
7 New Business ..................................................................................................... 9
7.1 Dealing Direct With Insureds ................................................................................ 9
7.2 Giving The FSG – General Principles ................................................................... 9
7.3 Quotations .......................................................................................................... 11
7.4 General Advice ................................................................................................... 11
7.5 Giving A PDS – General Principles .................................................................... 12
7.6 ‘Time Critical’ Transactions ................................................................................. 12
7.7 Dealing Through A Broker .................................................................................. 13
7.8 Cover Notes/Interim Contracts ........................................................................... 14
7.9 Handling Proposals – General Principles ........................................................... 14
7.10 Handling Proposals – Code Requirements ......................................................... 16
7.11 Declined Cover ................................................................................................... 16
8 Premium Payments And Refunds ................................................................... 17
8.1 Dealing Direct With Insureds .............................................................................. 17
8.2 Dealing Through Brokers .................................................................................... 17
8.3 Premium Funding ............................................................................................... 18
8.4 Trust Accounts .................................................................................................... 18
8.5 Return Premium ................................................................................................. 18
9 Policy Issuance And Certificates .................................................................... 19
9.1 Giving Insurance Documents .............................................................................. 19
9.2 Certificates Of Insurance .................................................................................... 19
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9.3 Noting Interests, Co-Insureds Or Contracts ........................................................ 19
9.4 Confirmation (Retail Clients) ............................................................................... 20
9.5 Cooling Off Period (Retail Clients) ...................................................................... 21
9.6 Certificates Of Currency ..................................................................................... 21
10 Renewals ........................................................................................................... 22
10.1 Renewal Preparation .......................................................................................... 22
10.2 Declining To Renew ........................................................................................... 22
10.3 Post Renewal Checking...................................................................................... 22
11 Endorsements, Lapses And Cancellation ...................................................... 23
11.1 Endorsements .................................................................................................... 23
11.2 Lapses ................................................................................................................ 23
11.2.1. Broker Business ................................................................................................. 23
11.2.2. Direct Business .................................................................................................. 23
11.3 Cancellations ...................................................................................................... 23
11.3.1. Cancelling To The Inception Date ...................................................................... 23
11.3.2. General Guidelines ............................................................................................ 23
12 Trust Accounts And Taxes .............................................................................. 24
13 Claims And Complaints ................................................................................... 25
14 Records Management ...................................................................................... 25
Detailed Table of Contents .............................................................................................. 27
The Fold’s Product Licence Terms and Conditions are available from our website at:
http://www.thefoldlegal.com.au/product-licence-terms-conditions.
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DETAILED TABLE OF CONTENTS
About the Companion to the Underwriter Manual ............................................................ 2
Financial Services ............................................................................................................... 5
1 Overview .............................................................................................................. 5
2 Retail / Wholesale Clients ................................................................................... 6
2.1 Retail Clients ......................................................................................................... 6
2.2 Wholesale Clients .................................................................................................. 7
2.3 Bundled Policies .................................................................................................... 8
3 Advising ............................................................................................................... 8
3.1 What Is Advice? .................................................................................................... 8
3.2 What Is Not Advice ................................................................................................ 9
3.2.1. Factual Information ............................................................................................. 10
3.2.2. “Disclosure” Documents...................................................................................... 10
3.2.3. Quotations .......................................................................................................... 10
3.2.4. Advertising .......................................................................................................... 11
3.2.5. General Advice Without Remuneration ............................................................... 11
4 General Advice And Personal Advice ............................................................. 11
4.1 Forms of Advice .................................................................................................. 11
4.2 Personal Advice .................................................................................................. 12
4.3 General Advice .................................................................................................... 13
4.3.1. When Does General Advice Become Personal Advice ....................................... 14
4.3.2. General Advice Warnings ................................................................................... 15
5 Dealing ............................................................................................................... 15
5.1 Dealing ................................................................................................................ 15
5.2 Arranging ............................................................................................................. 16
6 Non-Financial Services ..................................................................................... 17
6.1 Referrals .............................................................................................................. 17
6.2 Clerks And Cashiers ............................................................................................ 18
6.3 Passing On Prepared Documents ....................................................................... 18
6.4 Claims Handling .................................................................................................. 18
6.5 Group Purchasing Bodies ................................................................................... 19
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Marketing ........................................................................................................................... 22
7 Describing Your Business ................................................................................ 22
7.1 Holding Out ......................................................................................................... 22
7.2 Restricted Terms ................................................................................................. 23
7.3 Business Documents ........................................................................................... 24
7.3.1. AFS Licence Number .......................................................................................... 24
7.3.2. Australian Company Number And Australian Business Number ......................... 24
7.4 Business Names ................................................................................................. 26
8 Advertising......................................................................................................... 26
8.1 Disclosures .......................................................................................................... 26
8.2 Advertising........................................................................................................... 27
8.3 Mass Media ......................................................................................................... 29
9 Direct Marketing ................................................................................................ 30
9.1 General Principles ............................................................................................... 30
9.1.1. Marketing Material .............................................................................................. 30
9.1.2. Lists .................................................................................................................... 31
9.1.3. Privacy ............................................................................................................... 31
9.1.4. No Contact / No Call Register ............................................................................. 31
9.2 Telemarketing ...................................................................................................... 32
9.2.1. Federal Do Not Call Register .............................................................................. 32
9.3 Hawking .............................................................................................................. 33
9.3.1. What Is An Unsolicited Meeting/Call ................................................................... 33
9.3.2. Illegal Hawking ................................................................................................... 34
9.3.3. Permitted Hawking ............................................................................................. 34
9.3.4. Future Ban on Hawking ...................................................................................... 35
9.4 Electronic Marketing/Spam.................................................................................. 35
9.4.1. What Is Spam? ................................................................................................... 35
9.4.2. What Is Not Spam?............................................................................................. 36
9.4.3. What Is Consent? ............................................................................................... 36
9.4.4. Address Harvesting Lists .................................................................................... 37
9.5 Newsletters.......................................................................................................... 37
10 Other Marketing Strategies............................................................................... 38
10.1 Online/Internet Transactional Sites ..................................................................... 38
10.1.1. Lloyd’s Coverholders .......................................................................................... 38
10.2 Referrals .............................................................................................................. 39
10.2.1. Limits On Activities ............................................................................................. 39
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10.2.2. Disclosing Remuneration .................................................................................... 40
10.2.3. Monitoring Referrers ........................................................................................... 40
10.3 Lead Generation .................................................................................................. 41
10.4 Alliances .............................................................................................................. 41
11 Competition And Consumer Obligations ........................................................ 43
11.1 Misleading And Deceptive Conduct ..................................................................... 44
11.2 False Representations ........................................................................................ 46
11.3 Unconscionable Conduct .................................................................................... 46
11.4 Harassment Or Coercion ..................................................................................... 47
11.5 Third Line Forcing ............................................................................................... 47
11.6 Consumer Guarantees ........................................................................................ 47
11.7 Unfair Contracts .................................................................................................. 48
11.8 Penalties ............................................................................................................. 49
11.9 Deferred Sales Model For Add-On Insurance ..................................................... 49
Duties to the Insured and the Insurer .............................................................................. 51
12 Provision Of Services ....................................................................................... 51
12.1 Efficient, Honest And Fair .................................................................................... 51
12.2 General Insurance Code Of Practice ................................................................... 51
12.2.1. Lloyd’s Coverholders .......................................................................................... 54
13 Acting As Agent Of The Insurer ....................................................................... 54
13.1 General Principles ............................................................................................... 54
13.2 Lloyd’s Coverholders ........................................................................................... 55
13.2.1. Binding Authority and Undertaking ...................................................................... 55
13.2.2. Other Lloyd’s Requirements ............................................................................... 56
14 Remuneration Disclosure ................................................................................. 57
14.1 General Principles ............................................................................................... 57
14.2 Remuneration Types ........................................................................................... 58
14.2.1. Commissions And Fees ...................................................................................... 58
14.2.2. Alternative Remuneration ................................................................................... 58
14.2.3. Rebates And Related Payments ......................................................................... 58
14.2.4. Wholesale Clients ............................................................................................... 59
14.3 When Remuneration Must Be Disclosed ............................................................. 59
14.3.1. FSG .................................................................................................................... 59
14.3.2. Content of Disclosure ......................................................................................... 60
14.4 When Remuneration Need Not Be Disclosed...................................................... 60
15 Privacy And Confidentiality .............................................................................. 61
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15.1 Use Of Personal Information ............................................................................... 61
15.2 Collection Of Personal Information ...................................................................... 62
15.3 Privacy Procedures ............................................................................................. 62
15.3.1. Information Collection ......................................................................................... 62
15.3.2. Unsolicited Collection ......................................................................................... 63
15.3.3. Use and Disclosure Of Personal Information ...................................................... 64
15.3.4. Overseas Disclosure ........................................................................................... 64
15.3.5. Sensitive Personal Information ........................................................................... 65
15.3.6. Openness ........................................................................................................... 65
15.3.7. Direct Marketing ................................................................................................. 66
15.3.8. Quality, Security and Destruction of Information ................................................. 67
15.3.9. Correcting Personal Information ......................................................................... 67
15.3.10. Access ................................................................................................................ 68
15.3.11. Timeframe for Access and Correction ................................................................. 68
15.3.12. Charges For Access and Correction ................................................................... 68
15.3.13. Refusing Access ................................................................................................. 69
15.3.14. Giving Reasons .................................................................................................. 69
15.3.15. Complaints ......................................................................................................... 69
15.3.16. Tax File Numbers And Other Identifiers .............................................................. 69
15.3.17. Privacy Breaches ................................................................................................ 71
15.3.18. Privacy Policy Template...................................................................................... 72
15.3.19. Privacy Collection Statements and Scripts .......................................................... 75
15.3.20. Letters and scripts in relation to Service Providers .............................................. 80
15.3.21. Data Breach Response Plan ............................................................................... 85
16 Conflicts Of Interest .......................................................................................... 88
16.1 Conflicts Of Interest Policy .................................................................................. 88
16.1.1. What Is A Conflict Of Interest? ............................................................................ 88
16.2 Managing Conflicts Of Interest ............................................................................ 89
16.2.1. Controlling Conflicts ............................................................................................ 89
16.2.2. Disclosing Conflicts............................................................................................. 89
16.2.3. Avoiding Conflicts ............................................................................................... 90
16.3 Commercial Conflicts .......................................................................................... 90
16.4 Related Company Conflicts ................................................................................. 91
16.5 Related Company Conflicts Procedure ............................................................... 93
16.6 Conflicts Disclosures ........................................................................................... 94
17 Products And Services ..................................................................................... 95
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17.1 Product Development .......................................................................................... 95
17.1.1. Market Knowledge .............................................................................................. 95
17.1.2. Product Research ............................................................................................... 96
17.1.3. Design and Distribution Obligations .................................................................... 96
17.2 Insurer Selection ................................................................................................. 97
17.2.1. Lloyd’s Coverholders .......................................................................................... 97
17.2.2. Authorisation By APRA-Regulated Insurers ........................................................ 98
17.2.3. Overseas Or Foreign Insurers............................................................................. 98
17.3 Direct Offshore Foreign Insurers / Unauthorised Foreign Insurers ...................... 98
17.3.1. High Value Insureds ........................................................................................... 98
17.3.2. Atypical Risks ..................................................................................................... 99
17.3.3. Insurance Required By Foreign Law ................................................................... 99
17.3.4. Risks That Cannot Be Placed In The Australian Market .................................... 100
17.3.5. Proposed Regulation of Foreign Financial Service Providers ............................ 100
17.4 Accessing The DOFI Exemptions ...................................................................... 101
17.4.1. Notice To Insureds ........................................................................................... 101
17.4.2. Reporting To APRA .......................................................................................... 102
17.4.3. Lodgement Of Forms ........................................................................................ 102
17.4.4. More Than One Licensee Placing DOFI / UFI Business .................................... 103
17.4.5. Authorised Representatives Placing DOFI / UFI Business ................................ 103
18 Premium Funding ............................................................................................ 103
19 Underwriting .................................................................................................... 105
19.1 Underwriting Procedures ................................................................................... 105
19.2 Rating Guides .................................................................................................... 108
19.2.1. Lloyd’s Coverholders ........................................................................................ 108
19.3 Authorities ......................................................................................................... 108
19.4 Limit Management ............................................................................................. 108
19.4.1. Overlining ......................................................................................................... 108
19.4.2. Gross Premium Income Limits (GPI) / Gross Written Premium Limits (GWP) ... 109
20 Retail Client Disclosure .................................................................................. 109
20.1 Financial Services Guide ................................................................................... 109
20.1.1. What Must Be Included In An FSG ................................................................... 110
20.1.2. When Must An FSG Be Provided ...................................................................... 111
20.1.3. Time Critical Transactions ................................................................................ 112
20.1.4. Secondary Services .......................................................................................... 113
20.1.5. When An FSG Is Not Required ......................................................................... 113
20.1.6. How Must The FSG Be Provided ...................................................................... 115
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20.1.7. FSG Record Keeping ........................................................................................ 116
20.1.8. Penalties........................................................................................................... 116
20.2 Product Disclosure Statements ......................................................................... 117
20.2.1. What Is A PDS? ................................................................................................ 117
20.2.2. Updating PDSs ................................................................................................. 119
20.2.3. Direct Offshore Foreign Insurers (DOFIs) ......................................................... 120
20.2.4. Dollar Disclosure .............................................................................................. 121
20.2.5. When Must A PDS Be Provided? ...................................................................... 122
20.2.6. When Is A PDS Not Required? ......................................................................... 122
20.2.7. Bundled Contracts ............................................................................................ 123
20.2.8. Providing The PDS ........................................................................................... 123
20.2.9. Time Critical Cases........................................................................................... 124
20.2.10. PDS Record Keeping ........................................................................................ 125
20.2.11. Penalties........................................................................................................... 125
20.3 Confirmation ...................................................................................................... 126
20.3.1. Lloyd’s Coverholders ........................................................................................ 127
20.4 Cooling Off Period ............................................................................................. 127
20.4.1. Length Of Cooling Off Period ............................................................................ 127
20.4.2. When It Does And Doesn’t Apply ...................................................................... 127
20.4.3. Premium Refund ............................................................................................... 128
20.5 Cooling Off Notice ............................................................................................. 128
21 Dealing With Vulnerable Insureds ................................................................. 129
21.1 Vulnerable Customers ....................................................................................... 129
21.2 Family Violence Policy ...................................................................................... 130
22 Insurance Proposals ....................................................................................... 131
22.1 Restrictions On Dealing With Certain Insureds ................................................. 131
22.1.1. Illegal Foreign Insureds .................................................................................... 131
22.1.2. Compliance Measures ...................................................................................... 132
22.2 Guidance For Lloyd’s Coverholders .................................................................. 133
22.2.1. International Sanctions ..................................................................................... 133
22.2.2. UK Anti-Money Laundering And Anti-Bribery Laws ........................................... 134
23 New Business .................................................................................................. 136
23.1 Interim Contracts ............................................................................................... 136
23.1.1. Lloyd’s Coverholders ........................................................................................ 136
23.2 Proposals .......................................................................................................... 136
23.2.1. Handling Proposals........................................................................................... 136
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23.2.2. Reviewing Proposals ........................................................................................ 137
23.2.3. Duty Of Disclosure ............................................................................................ 138
23.2.4. Future changes to Duty of Disclosure ............................................................... 141
23.2.5. Other Disclosure ............................................................................................... 141
23.3 Declined Cover Or Variations In Terms ............................................................. 141
23.4 Payment And Refunds Of Premium .................................................................. 142
23.4.1. Timeframes For Payment ................................................................................. 142
23.4.2. Details Of The Premium.................................................................................... 142
23.4.3. Timeframes For Premium Refunds ................................................................... 142
23.5 Disclosure Notices ............................................................................................. 143
24 Renewals .......................................................................................................... 148
24.1 Renewal Preparation ......................................................................................... 148
24.2 Renewal Underwriting ....................................................................................... 148
24.3 Declining To Renew .......................................................................................... 150
24.4 Post Renewal Checking .................................................................................... 150
25 Insurance Certificates ..................................................................................... 151
25.1 Certificates Of Insurance And Contract Certainty .............................................. 151
25.1.1. Lloyd’s Coverholders ........................................................................................ 151
25.2 Certificates Of Currency .................................................................................... 152
26 Endorsements, Lapses And Cancellations ................................................... 152
26.1 Endorsements ................................................................................................... 152
26.2 Lapses ............................................................................................................... 152
26.2.1. Broker Business ............................................................................................... 152
26.2.2. Direct Business ................................................................................................. 152
26.3 Cancellation By The Insured Or Broker ............................................................. 153
26.3.1. Joint Insureds ................................................................................................... 153
26.3.2. Confirmation Of Insured’s Request For Cancellation ......................................... 153
26.3.3. Effective Date Of Cancellation .......................................................................... 153
26.3.4. Return Premium ............................................................................................... 153
26.4 Cancellation By The Insurer .............................................................................. 154
26.5 Cancellation Procedure ..................................................................................... 154
26.5.1. Notice In Writing ............................................................................................... 154
26.5.2. Instalment Contracts ......................................................................................... 155
26.5.3. Short-Term Premium ........................................................................................ 155
26.5.4. Adjustments ...................................................................................................... 155
27 Communications ............................................................................................. 156
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27.1 Write, Read And Respond ................................................................................. 156
27.1.1. Write ................................................................................................................. 156
27.1.2. Read ................................................................................................................. 156
27.1.3. Respond ........................................................................................................... 156
27.2 Diary System ..................................................................................................... 157
27.3 Telephone Calls / Messages ............................................................................. 157
27.3.1. Telephone Messages ....................................................................................... 157
27.3.2. Telephone Calls ................................................................................................ 157
27.4 Written Communications ................................................................................... 158
27.4.1. Correspondence ............................................................................................... 158
27.4.2. Facsimiles ........................................................................................................ 158
27.4.3. Distribution System ........................................................................................... 158
27.5 Email ................................................................................................................. 158
27.5.1. Email Signoff .................................................................................................... 158
27.5.2. Email Usage ..................................................................................................... 159
27.5.3. Security ............................................................................................................ 159
27.5.4. Checking Emails ............................................................................................... 160
27.5.5. Retention .......................................................................................................... 160
27.5.6. Viruses ............................................................................................................. 160
Trust Accounts and Taxation ......................................................................................... 161
28 Handling Money ............................................................................................... 161
28.1 Separation Of Front And Back Office ................................................................ 161
28.1.1. Receipts ........................................................................................................... 161
28.1.2. Claims Payments .............................................................................................. 161
28.2 Whose Money Is It? ........................................................................................... 163
28.2.1. Handling Money For The Insurer ...................................................................... 163
28.2.2. Money Held By Underwriting Agencies ............................................................. 164
28.2.3. Money Held By Brokers .................................................................................... 164
29 Trust Accounts ................................................................................................ 165
29.1 Section 981B Trust Account .............................................................................. 165
29.2 Interest .............................................................................................................. 166
29.3 Trust Money ...................................................................................................... 166
29.3.1. Money Which Must Be Paid In .......................................................................... 166
29.3.2. Money Which May Be Paid In ........................................................................... 166
29.3.3. Money Which Cannot Be Paid In ...................................................................... 167
29.4 Permissible Payments from trust account ......................................................... 167
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29.5 Times For Payment ........................................................................................... 168
29.5.1. Payments Into Section 981B Trust Account ...................................................... 168
29.5.2. Payments To Insurers ....................................................................................... 168
29.5.3. Payments To Insureds ...................................................................................... 169
29.5.4. Payments To The Broker .................................................................................. 169
29.6 Notices .............................................................................................................. 169
29.6.1. Policy Not Issued .............................................................................................. 169
29.6.2. Payments Between Intermediaries.................................................................... 169
29.7 Trust Account Controls ...................................................................................... 170
29.7.1. Receipts / Transaction Confirmation ................................................................. 170
29.7.2. Authorised Signatories ...................................................................................... 170
29.7.3. Account Balance ............................................................................................... 170
29.7.4. Reconciliation ................................................................................................... 171
29.7.5. Account Statements.......................................................................................... 171
29.7.6. Record-Keeping ................................................................................................ 171
29.7.7. Physical Security .............................................................................................. 171
29.7.8. Audit Of Trust Accounts .................................................................................... 171
29.8 Investing Client Money ...................................................................................... 171
30 Credit Terms .................................................................................................... 172
30.1 Credit Control .................................................................................................... 172
30.2 Broker Administration Agreements .................................................................... 173
30.3 Follow-Up System ............................................................................................. 174
31 Insurance Taxes .............................................................................................. 174
31.1 Taxes And Charges ........................................................................................... 174
31.2 Emergency Services Levy ................................................................................. 174
31.2.1. New South Wales ............................................................................................. 174
31.2.2. Victoria ............................................................................................................. 176
31.2.3. Tasmania.......................................................................................................... 176
31.3 Goods And Services Tax ................................................................................... 177
31.3.1. Premium ........................................................................................................... 177
31.3.2. Commission And Admin Fees ........................................................................... 178
31.4 Stamp Duty........................................................................................................ 179
31.4.1. New South Wales ............................................................................................. 179
31.4.2. Victoria ............................................................................................................. 180
31.4.3. Queensland ...................................................................................................... 180
31.4.4. Australian Capital Territory ............................................................................... 181
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31.4.5. Tasmania.......................................................................................................... 181
31.4.6. Western Australia ............................................................................................. 181
31.4.7. South Australia ................................................................................................. 181
31.4.8. Northern Territory ............................................................................................. 181
31.5 Foreign Resident Withholding Tax .................................................................... 182
31.6 Responsibility For Payment Of Taxes ............................................................... 182
31.6.1. Authorised Insurers........................................................................................... 182
31.6.2. Lloyd’s Coverholders ........................................................................................ 182
31.6.3. DOFIS .............................................................................................................. 182
31.7 Penalties ........................................................................................................... 183
31.8 Emergency Services Levy Summary ................................................................. 184
31.9 Stamp Duty Summary ....................................................................................... 185
Claims and Complaints .................................................................................................. 190
32 Claims Services ............................................................................................... 190
32.1 Standards .......................................................................................................... 190
32.2 Resourcing ........................................................................................................ 190
32.2.1. Authorities ........................................................................................................ 190
32.2.2. Adequacy Of Resources ................................................................................... 191
32.3 Use Of Claims Consultants ............................................................................... 192
32.3.1. Selection........................................................................................................... 192
32.3.2. Panels .............................................................................................................. 192
32.4 External Experts, Adjustors and Investigators ................................................... 193
32.4.1. Expertise and service standards ....................................................................... 193
32.4.2. Panels .............................................................................................................. 193
32.5 Medical Experts ................................................................................................. 194
32.6 Solicitors ............................................................................................................ 194
32.7 Claims Handling Standards for Investigators..................................................... 195
32.8 Retainers / Agreements ..................................................................................... 197
32.9 Privacy .............................................................................................................. 198
32.9.1. Privacy ............................................................................................................. 198
32.9.2. Implementation ................................................................................................. 199
32.10 Guidelines For Use Of Claims Consultants ....................................................... 199
32.11 Monitoring Performance .................................................................................... 199
32.11.1. Monitoring ......................................................................................................... 199
32.11.2. Complaints ....................................................................................................... 200
32.11.3. Breach Of Service Standards............................................................................ 200
32.11.4. Fees ................................................................................................................. 200
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32.11.5. Internal Audit .................................................................................................... 200
32.12 Breaches ........................................................................................................... 200
32.12.1. Non-Licence Breaches Or Fees Issues ............................................................. 200
32.12.2. Licence Breaches ............................................................................................. 201
32.12.3. Reporting .......................................................................................................... 201
33 Handling And Managing Claims ..................................................................... 201
33.1 Notification By The Insured / Broker .................................................................. 201
33.2 Standards For Claims Handling ......................................................................... 202
33.3 Insured/Broker Access To Claims Files ............................................................. 202
33.4 Timeframes ....................................................................................................... 203
33.5 Notification To Insurers ..................................................................................... 205
33.6 Verification......................................................................................................... 205
33.7 Initial Reserve .................................................................................................... 205
33.8 Recording .......................................................................................................... 206
33.9 Dealing Directly With Insureds And Claimants .................................................. 206
33.10 Investigation ...................................................................................................... 206
33.11 Management ..................................................................................................... 207
33.12 Reserving .......................................................................................................... 207
33.12.1. Reserving Authority .......................................................................................... 208
33.13 Follow Up And Review ...................................................................................... 208
33.14 Statutes Of Limitation ........................................................................................ 209
33.14.1. Limitation Periods ............................................................................................. 209
33.14.2. Claims By Minors .............................................................................................. 209
33.15 Declined Claims ................................................................................................ 209
33.16 Litigated Claims ................................................................................................. 210
33.16.1. For Lloyd’s Coverholders .................................................................................. 210
34 Claims Settlement ........................................................................................... 210
34.1 Settlement Authority .......................................................................................... 210
34.2 Repairs, Workmanship And Materials (Preferred Repairers)............................. 211
34.3 Repayments ...................................................................................................... 211
34.4 Releases ........................................................................................................... 211
34.5 Cash Calls ......................................................................................................... 212
34.5.1. For Lloyd’s Coverholders .................................................................................. 212
34.6 Runoff ................................................................................................................ 212
34.7 Payment To Claimant/Insured ........................................................................... 212
34.8 Payment To Claimant/Insured – Financial Hardship ......................................... 212
34.9 Payment To Claimant/Insured – Cash Settlements and Total Loss Claims ...... 214
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34.10 Liaising With Insurers ........................................................................................ 215
34.10.1. Reporting .......................................................................................................... 215
34.10.2. Instructions ....................................................................................................... 215
34.11 Dealing With Brokers ......................................................................................... 215
34.11.1. Claims Histories ................................................................................................ 216
34.12 Recoveries ........................................................................................................ 216
34.12.1. Liability Claims.................................................................................................. 216
34.12.2. Property Claims ................................................................................................ 216
34.12.3. Instalment Payments ........................................................................................ 216
34.13 Financial Hardship (Third Party Recoveries) ..................................................... 217
34.14 Catastrophes And Disasters .............................................................................. 218
34.15 Financial Management ...................................................................................... 218
34.15.1. Monitoring Aggregate Exposure ........................................................................ 218
34.15.2. Managing Cash Requirements.......................................................................... 218
34.16 Service Standard Breach Report ....................................................................... 219
35 Complaints And Disputes ............................................................................... 219
35.1 Why Have A Complaints Policy And Procedures? ............................................ 219
35.2 What Is A Complaint Or Dispute? ...................................................................... 219
35.3 Complaints And Disputes Policy ........................................................................ 220
35.4 Guidelines For When You Receive A Complaint ............................................... 220
35.5 Complaints And Disputes About Insurers .......................................................... 221
35.6 External Dispute Resolution .............................................................................. 222
35.7 Record Keeping ................................................................................................. 223
Detailed Table of Contents ............................................................................................. 225
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