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Status: You are viewing the version of the handbook as on 2009-03-31.

ICOBS 8.1 Insurers: general

ICOBS 8.1.1RRP

1An insurer must:

  1. (1)

    handle claims promptly and fairly;

  2. (2)

    provide reasonable guidance to help a policyholder make a claim and appropriate information on its progress;

  3. (3)

    not unreasonably reject a claim (including by terminating or avoiding a policy); and

  4. (4)

    settle claims promptly once settlement terms are agreed.

ICOBS 8.1.2RRP

A rejection of a consumer policyholder's claim is unreasonable, except where there is evidence of fraud, if it is for:

  1. (1)

    non-disclosure of a fact material to the risk which the policyholder could not reasonably be expected to have disclosed; or

  2. (2)

    non-negligent misrepresentation of a fact material to the risk; or

  3. (3)

    breach of warranty or condition unless the circumstances of the claim are connected to the breach and unless (for a pure protection contract):

    1. (a)

      under a ‘life of another’ contract, the warranty relates to a statement of fact concerning the life to be assured and, if the statement had been made by the life to be assured under an ‘own life’ contract, the insurer could have rejected the claim under this rule; or

    2. (b)

      the warranty is material to the risk and was drawn to the customer's attention before the conclusion of the contract.