COB 8A.2 Claims handling: general
Requirements to handle claims promptly and fairly
An insurer must carry out claims handling promptly and fairly.
An insurer should refer to the guidance in SYSC 3.2 (Areas covered by systems and controls) in its procedures for claims handling. For example, an insurer should have in place systems and controls which take account of reasonably foreseeable peaks in demand, to allow it to deal with claims promptly in such circumstances.
An insurer should refer to the guidance set out in TC 1 (Commitments) in respect of the competence of any person who carries out claims handling on its behalf.
Giving policyholders guidance on claiming
When an insurer is informed that a policyholder wishes to claim under his policy it must give the policyholder reasonable guidance to help him make a claim under his policy.
Rejecting or refusing claims
An insurer must not:
- (1)
unreasonably reject a claim made by a policyholder;
- (2)
except where there is evidence of fraud, refuse to meet a claim made by a policyholder on the grounds:
- (a)
of non-disclosure of a fact material to the risk which the policyholder could not reasonably be expected to have disclosed;
- (b)
of misrepresentation of a fact material to the risk unless the misrepresentation is negligent; or
- (c)
of breach of warranty, unless the circumstances of the claim are connected with the breach and unless:
- (i)
under a 'life of another' contract, the warranty relates to a statement of fact concerning the life to be assured and that statement would have constituted grounds for rejection of a claim by the insurer under COB 8A.2.6R (2)(a) or COB 8A.2.6R (2)(b) if it had been made by the life to be assured under an 'own life' contract; or
- (ii)
the warranty is material to the risk and was drawn to the attention of the policyholder before the conclusion of the contract.
- (i)
- (a)