Related provisions for ICOBS 8.2.7

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(1) This section applies to a motor vehicle liability insurer.(2) The rules in this section relating to the appointment of claims representatives apply:22(a) [deleted]32(b) in relation to claims arising out of events occurring, and risks situated, in the United Kingdom, and covered by a firm operating from an establishment in the European Economic Area3.2(3) The rules in this section relating to claims handling apply in respect of claims arising from any accident caused by a vehiclenormally
A firm operating from an establishment in the European Economic Area3 carrying on motor vehicle liability insurance business and covering UK risks 3must have a claims representative in the United Kingdom to deal with claims arising out of events occurring in the United Kingdom.[Note: article 152 of the Solvency II Directive]2
A firm must ensure that each claims representative:(1) is responsible for handling and settling a claim by an injured party;(2) is resident or established in the United Kingdom3;(3) collects all information necessary in connection with the settlement of a claim and takes the measures necessary to negotiate its settlement;(4) possesses sufficient powers to represent the firm in relation to an injured party and to meet an injured party's claim in full; and(5) is capable of examining
The requirement to possess sufficient powers does not prevent a claims representative from seeking additional authority or instructions if needed. It does prevent it from declining to deal with, or transferring responsibility for, claims properly referred to it by an injured party, or their representative.
Within three months of the injured party presenting his claim for compensation:(1) the firm of the person who caused the accident or its claims representative must make a reasoned offer of compensation in cases where liability is not contested and the damages have been quantified; or(2) the firm to whom the claim for compensation has been addressed or its claims representative must provide a reasoned reply to the points made in the claim in cases where liability is denied or has
A claim for damages will be fully quantified for the purpose of this section when the injured party provides written evidence which substantiates or supports the amounts claimed.
(1) If the firm, or its claims representative, does not make an offer as required by this section, the firm must pay simple interest on the amount of compensation offered by it or awarded by the court to the injured party, unless interest is awarded by any tribunal.(2) The interest calculation period begins when the offer should have been made and ends when the compensation is paid to the injured party, or his authorised representative.(3) The interest rate is the Bank of England's
A firm will be taken to have received a claim, or a fully quantified claim, for damages when the claim is delivered to it, or a claims representative, by any person by any method of delivery which is lawful in the firm's, or its claims representative's, respective State of residence or establishment.
This section applies to an insurance intermediary, and to an insurer handling a claim on another insurance undertaking'spolicy.
(1) Principle 8 requires a firm to manage conflicts of interest fairly. SYSC 10 also requires an insurance intermediary to take all reasonable steps to identify conflicts of interest, and maintain and operate effective organisational and administrative arrangements to prevent conflicts of interest from constituting or giving rise to a material risk of damage to its clients. 1(2) [deleted]11(3) If a firm acts for a customer in arranging a policy, it is likely to be the customer's
A firm that does not have authority to deal with a claim should forward any claim notification to the insurance undertaking promptly, or inform the policyholder immediately that it cannot deal with the notification.
COBS 17.1.1RRP
1When an insurer or managing agent receives a claim under a long-term care insurance contract, it must respond promptly by providing the policyholder, or the person acting on the policyholder's behalf, with:(1) a claim form (if it requires one to be completed);(2) a summary of its claims handling procedure; and(3) appropriate information about the medical criteria that must be met, and any waiting periods that apply, under the terms of the policy.
COBS 17.1.2RRP
As soon as reasonably practicable after receipt of a claim, the insurer or managing agent must tell the policyholder, or the person acting on the policyholder's behalf:(1) (for each part of the claim it accepts), whether the claim will be settled by paying the policyholder, providing goods or services to the policyholder or paying another person to provide those goods or services; and(2) (for each part of the claim it rejects), why the claim has been rejected and whether any future
COBS 17.1.3RRP
An insurer and a managing agent must not unreasonably reject a claim.2
1An insurer must:(1) handle claims promptly and fairly;(2) provide reasonable guidance to help a policyholder make a claim and appropriate information on its progress; (3) not unreasonably reject a claim (including by terminating or avoiding a policy); and(4) settle claims promptly once settlement terms are agreed.
(1) 3Cases in which rejection of a consumer’s claim would be unreasonable (in the FCA’s view) include, but are not limited to rejection:(a) for misrepresentation, unless it is a qualifying misrepresentation (see ICOBS 8.1.3R);(b) where the claim is subject to the Insurance Act 2015, for breach of warranty or term, or for fraud, unless the insurer is able to rely on the relevant provisions of the Insurance Act 2015; and(c) where the policy is drafted or operated in a way that does
3For contracts entered into or variations agreed on or after 1 August 2017, a rejection of a consumerpolicyholder's claim for breach of a condition or warranty (that is not subject to and within section 10 or 11 of the Insurance Act 2015) is unreasonable unless the circumstances of the claim are connected to the breach.
Put another way, where an intermediary's assistance in filling in a claims form is material to whether performance takes place of the contractual obligation to notify claims, it is more likely to amount to assisting in the administration and performance of a contract of insurance. Conversely, in the FCA's view, a person who merely gives pointers about how to fill in the claims form or merely supplies information in support of a claim will not be assisting in the performance of
More generally, an example of an activity that, in the FCA's view, is likely to amount to assisting a policyholder in both the administration and the performance of a contract of insurance is notifying a claim under a policy and then providing evidence in support of the claim, or helping negotiate its settlement on the policyholder's behalf. Notifying an insurance undertaking of a claim assists the policyholder in discharging his contractual obligation to do so (assisting in the
Where a person receives funds on behalf of a policyholder in settlement of a claim, in the FCA's view, the act of receipt is likely to amount to assisting in the performance of a contract. By giving valid receipt, the person assists the insurance undertaking to discharge its contractual obligation to provide compensation to the policyholder. He may also be assisting the policyholder to discharge any obligations he may have under the contract to provide valid receipt of funds,
A firm must:(1) where it has responsibility for doing so, explain the key features of a regulated credit agreement to enable the customer to make an informed choice as required by CONC 4.2.5 R;[Note: paragraphs 4.27 to 4.30 of CBG and 2.2 of ILG](2) take reasonable steps to satisfy itself that a product it wishes to recommend to a customer is not unsuitable for the customer's needs and circumstances;[Note: paragraph 4.22 of CBG](3) advise a customer to read, and allow the customer
(1) It is likely to be an inappropriate offer of an inducement or incentive to enter into an regulated credit agreement or a regulated consumer hire agreement to state that the offer in relation to the agreement will be withdrawn or the terms and conditions of the offer will worsen if the agreement is not signed immediately or within a stated period after the communication, unless the firm's offer on those terms and conditions will in fact be withdrawn or worsen in the period
CONC 2.5.11GRP
In CONC 2.5.8R (14) and CONC 2.5.10R (1), the protection offered by a payment protection product will typically be triggered by life events such as accident, sickness and/or unemployment, although other events may be covered where they impact on the consumer's ability to meet certain financial commitments. The triggering events will usually be specified in the agreement but may be subject to some discretion (by the provider) at the time of claim.
713If a complaint relates to the sale of a payment protection contract, knowledge by the complainant that there was a problem with the sale of the payment protection contract generally (for example where there has been a rejection of a claim on the grounds of ineligibility or exclusion, or the complainant has received a customer contact letter explaining that they may have been mis-sold) would not in itself ordinarily be sufficient to establish for the purposes of the three-year
(1) 713In addition to DISP 2.8.1R and DISP 2.8.2R, unless one or more of the conditions in (2) below is met, the Ombudsman cannot consider a complaint which:(a) relates to the sale of a payment protection contract that took place on or before 29 August 2017; and(b) expresses dissatisfaction about the sale, or matters related to the sale, including where there is a rejection of claims on the grounds of ineligibility or exclusion (but not matters unrelated to the sale, such as delays
DISP 2.8.10GRP
713Where a complaint meets the requirements of DISP 2.8.9R(2)(d), those parts of the complaint that relate to the grounds of rejection of the claim are not subject to the restriction in DISP 2.8.9R(1) on an Ombudsman considering the complaint.
RCB 2.3.5GRP
Regulations 17(2)(d) (requirements on issuer relating to the asset pool) and 23(2) (requirements on owner relating to the asset pool) require the issuer of a regulated covered bond and the owner of the relevant asset pool to make arrangements so that the asset pool is of sufficient quality to give investors confidence that in the event of the failure of the issuer there will be a low risk of default in the timely payment by the owner of claims attaching to a regulated covered
RCB 2.3.6GRP
The FCA will:(1) expect the issuer to demonstrate that it has in place appropriate systems, controls, procedures and policies, including in relation to risk management, underwriting, arrears and valuation; (2) expect the issuer to demonstrate that the cash-flows generated by the assets would be sufficient to meet the payments due in a timely manner including under conditions of economic stress and in the event of the failure of the issuer;(3) take account of any over collateralisation
RCB 2.3.18GRP
(1) The FCA expects the report from the accountants to address at least the following matters:(a) that the level of over collateralisation meets the limits set out in the covered bond arrangements which are designed to ensure compliance with the requirement that the asset pool is capable of covering claims attaching to the bond in Regulation 17 (requirements on issuer in relation to the asset pool) of the RCB Regulations; and(b) that appropriate due diligence procedures (which
(1) Agency agreements between insurance intermediaries and insurance undertakings may be of a general kind and facilitate the introduction of business to the insurance undertaking. Alternatively, an agency agreement may confer on the intermediary contractual authority to commit the insurance undertaking to risk or authority to settle claims or handle premium refunds (often referred to as "binding authorities"). CASS 5.2.3 R requires that binding authorities of this kind must
(1) A firm must not agree to:(a) deal in investments as agent for an insurance undertaking in connection with an insurance distribution activity3; or(b) act as agent for an insurance undertaking for the purpose of settling claims or handling premium refunds; or(c) otherwise receive money as agent of an insurance undertaking;unless:(d) it has entered into a written agreement with the insurance undertaking to that effect; and(e) it is satisfied on reasonable grounds that the terms
(1) CASS 5.4 permits a firm, which has adequate resources, systems and controls, to declare a trust on terms which expressly authorise it, in its capacity as trustee, to make advances of credit to the firm'sclients. The client money trust required by CASS 5.4 extends to such debt obligations which will arise if the firm, as trustee, makes credit advances, to enable a client's3premium obligations to be met before the premium is remitted to the firm and similarly if it allows claims
The deed referred to in CASS 5.4.6 R must provide that the money (and, if appropriate, designated investments) are held:(1) for the purposes of and on the terms of:(a) CASS 5.4;(b) the applicable provisions of CASS 5.5; and(c) the client money (insurance) distribution rules(2) subject to (41), for the clients (other than clients which are insurance undertakings when acting as such) 1for whom that money is held, according to their respective interests in it;(3) after all valid
(1) The Senior Management Arrangements, Systems and Controls sourcebook (SYSC) 2 contains high-level record-keeping requirements (see SYSC 3.2.20 R, 2SYSC 9.1.1 R and SYSC 9.1.1 AR2).1212(2) This sourcebook does not generally have detailed record-keeping requirements: firms will need to decide what records they need to keep in line with the high-level record-keeping requirements and their own business needs. (3) Firms should bear in mind the need to deal with requests for information
The conditions for the application of a conversion factor of 50% are:(1) the liquidity facility documentation must clearly identify and limit the circumstances under which the facility may be drawn;(2) it must not be possible for the facility to be drawn so as to provide credit support by covering losses already incurred at the time of drawdown, for example by providing liquidity for exposures in default at the time of drawdown or by acquiring assets at more than fair value;(3)
A conversion factor of 0% may be applied to the nominal amount of an unrated liquidity facility where the following conditions are met: (1) the conditions for a conversion factor of 50% in MIPRU 4.2BA.52 R are met;(2) the liquidity facility is unconditionally cancellable; and(3) repayment of any drawings on the facility are senior to any other claims on the cashflows arising from the securitised exposures.
CASS 7.19.25RRP
The records maintained under this section, including the sub-pool disclosure documents, are a record of the firm that must be kept in a durable medium for at least five years following the date on which client money was last held by the firm for a sub-pool to which those records or the sub-pool disclosure document applied.
However, the disaster recovery contracts considered by the FCA had two key features.(1) Priority access to facilities in the event of a disaster was expressed to be on a 'first come, first served' basis. The contracts provided expressly that if the facilities needed by recipient A were already in use, following an earlier invocation by recipient B, the provider's obligation to recipient A was reduced to no more than an obligation of 'best endeavours' to meet A's requirements.
PERG 6.7.17GRP
The following are examples of typical warranty schemes operated by motor dealers. Provided that, in each case, the FCA is satisfied that the obligations assumed by the dealer are not significantly more extensive in content, scope or duration that a dealer's usual obligations as to the quality of motor vehicles of that kind, the FCA would not usually classify the contracts embodying these transactions as contracts of insurance.(1) The dealer gives a verbal undertaking to the purchaser
The conditions referred to in ICOBS 8.4.4R (2)(d) and ICOBS 8.4.7R (1)(a)(ii) are that the tracing office is one which:(1) maintains a database which:(a) accurately and reliably stores information submitted to it by firms for the purposes of complying with these rules;(b) has systems which can adequately keep it up to date in the light of new information provided by firms;(c) has an effective search function which allows a person inputting data included on the database relating
(1) 2For the purposes of ICOBS 8.4.11R (2)(a), 8.4.11R (2)(b) and ICOBS 8 Annex 1 a claim is deemed to be made in relation to a policy at the date on which the firm establishes, or otherwise accepts, that it has provided relevant cover under the policy, and is therefore potentially liable subject to the terms of the policy.(2) A firm must use reasonable endeavours to establish whether it has provided relevant cover:(a) within three months of being notified of a potential claim;
4The reason for FEES 6.3.22A R is that any such claim should be dealt with under FEES 2.3 (Relieving Provisions).
The purposes of the long-term insurance business include the payment of claims, expenses and liabilities arising from that business, the acquisition of lawful access to fixed assets to be used in that business and the investment of assets. The payment of liabilities may include repaying a loan but only where that loan was incurred for the purpose of the long-term insurance business. The purchase or investment of assets may include an exchange at fair market value of assets (including
MCOB 4.11.7GRP
(1) A consideration of the customer's benefits position will need to focus on whether, by entering into the proposed regulated sale and rent back agreement, his entitlement to means-tested benefit will be adversely affected because of his receipt of the net proceeds of sale (if any) of the property. The customer's possible loss of entitlement to claim housing benefit should also be assessed. Where a firm has insufficient knowledge of means-tested and housing benefits to reach
A firm must not ignore or disregard a customer's claim that a debt has been settled or is disputed and must not continue to make demands for payment without providing clear justification and/or evidence as to why the customer's claim is not valid.[Note: paragraph 3.7o of DCG]
10The second element of a management expenses levy is a specific costs levy for the "specific costs" of running the compensation scheme in a financial year12. These costs are attributable to a class, and include the salary costs of certain staff of the FSCS and claims handling and legal and other professional fees. It also may include the cost of any insurance cover that FSCS secures against the risk of FSCS paying out claims above a given level in any particular class (but below