Related provisions for DISP App 1.5.17
21 - 40 of 58 items.
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.
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
The5 following exclusions do not apply if they concern transactions relating to contracts of insurance:(1) dealing in investments as agent with or through authorised persons (article 22 of the Regulated Activities Order (Deals with or through authorised persons));(2) arranging transactions to which the arranger is to be a party, where the arranger enters into or is to enter into the transaction:(a) as agent for another person; or(b) as principal, unless the arranger is the only
In the FCA's view, the liability risks referred to in PERG 5.11.13G (5) cover risks in relation to liabilities that the policyholder might have to others (that is, third party claims). Many policies will provide this sort of cover and so fall outside the scope of the exclusion. For example, a policy that covers the cost of unauthorised calls made when a mobile telephone is stolen includes 'liability risks' and would not be a 'connected contract of insurance'. By contrast, travel
Article 72D (Large risks contracts where risk situated outside the EEA) provides an exclusion for large risks situated outside the EEA. Broadly speaking, these are risks relating to:(1) railway rolling stock, aircraft, ships, goods in transit, aircraft liability and shipping liability;(2) credit and suretyship where relating to the policyholder's commercial or professional liability;(3) land vehicles, fire and natural forces, property damage, motor vehicle liability where the
23'Relevant benefits' are those benefits that fall outside what is required in order that policyholders' reasonable expectations at that point of sale can be fulfilled. (The phrase 'policyholders' reasonable expectations' has technically been superseded. However, the concept now resides within the obligations imposed upon firms by FCA Principle 6 ('...a firm must pay due regard to the interests of its customers and treat them fairly....') Additionally, most of these benefits would
If a firm (whether within or outside the scope of the Solvency II Directive)2 decides to cease to effect new contracts of insurance, it must, within 28 days of that decision, submit a run-off plan to the FCA3 including: (1) a scheme of operations; and (2) an explanation of how, or to what extent, all liabilities to policyholders (including, where relevant, liabilities which arise from the regulatory duty to treat customers fairly in setting discretionary benefits) will be met
If a firm intends either (a) to remedy a fall in capital resources, or (b) to prevent such a fall, for example, by taking management action to reduce the risks to which a with-profits fund is exposed or by reducing non-contractual benefits for policyholders, it should explain to the FCA how such proposed actions are consistent with the firm's obligations under Principle 6 (Customers' interests).
For the purposes of article 53(1)1, advice must be given to or directed at someone who either holds investments or is a prospective investor (or their agent). Where the investment is a risk-only contract of insurance such as house contents insurance, the policyholder or prospective policyholder is regarded as an investor.
It must be emphasised that activities which concern invitations to renew policies and the subsequent effecting of renewal of policies are likely to fall within insurance distribution activity2. Those considering the need for authorisation or variation of their permissions will wish to consider whether a process of tacit renewal operates: that is, where a policyholder need take no action if they wish to maintain their2 insurance cover by having their2policy 'renewed'. This process
When a long-term insurer receives any indication that a retail client wishes to surrender a life policy which is of the type that may be traded on an existing secondary market for life policies, it must, before accepting a surrender, make the policyholder aware that he may be able to sell his policy instead, how he may do so and that there may be financial benefits in doing so.
Article 21 of the Regulated Activities Order (Dealing in investments as agent) makes dealing in contracts of insurance as agent a regulated activity. The activity is defined in terms of buying, selling, subscribing for or underwriting contracts as agent, that is, on behalf of another. Examples include:(1) where an intermediary, by accepting on the insurance undertaking's behalf to provide the insurance, commits an insurance undertaking to provide insurance for a prospective policyholder;
A firm's run-off plan should include:(1) details of any changes that will be made to the firm's corporate governance arrangements as a consequence of closure;(2) an explanation of how costs charged to the with-profits fund may change in the light of closure;(3) an explanation of any changes it will make, as a consequence of closure, to any charges for guarantees, including:(a) the circumstances in which those charges may be varied in the future; or (b) the manner by which the
These tables belong to SUP App 2.15.8 G
Table 1 - forecast summary revenue account for the relevant with-profits fund |
|
(1) |
Premiums and claims (gross and net of reinsurance) analysed by major class of insurance business |
(2) |
Investment return |
(3) |
Expenses |
(4) |
Other charges and income |
(5) |
Taxation |
(6) |
Increase (decrease) in fund in financial year |
(7) |
Fund brought forward |
(8) |
Fund carried forward |
Table 2 - forecast summary balance sheet and statement of solvency for the relevant with-profits fund |
|
Assets analysed by type (excluding implicit items): |
|
(1) |
Equities |
(2) |
Land and buildings |
(3) |
Fixed interest investments |
(4) |
All other assets |
(5) |
Total assets (excluding implicit items) |
(6) |
Policyholder liabilities |
(7) |
Other liabilities |
(8) |
Total liabilities |
(9) |
Excess/(deficiency) of assets over liabilities before implicit items |
(10) |
Implicit items allocated to the with-profits fund |
(11) |
Long-term insurance capital requirement for the with-profits fund |
(12) |
|
(13) |
[deleted]4 4 |
(14) |
Net excess/(deficiency) of assets in the with-profits fund |
Table 3 - forecast summary balance sheet and statement of solvency for the firm |
||
L1 |
||
L2 |
||
L3 |
L1+L2 |
|
L4 |
Total long-term insurance liabilities (excluding resilience capital requirement) |
|
L5 |
Total long-term insurance fund surplus |
L3-L4 |
L6 |
Shareholder fund assets |
|
L7 |
||
L8 |
||
L9 |
Excess of regulatory assets over long-term insurance capital requirement |
L5+L6+L7-L8 |
L10 |
[deleted]4 4 |
4 |
L11 |
||
L12 |
Net excess assets |
L9-L10-L11 |
L13 |
FTSE level at which the long-term insurance capital requirement would be breached |
|
For the purposes of article 53(1)2, advice must be given to a person in that person’s’3 capacity as an investor or potential investor (which, in the context of contracts of insurance, will mean as policyholder or potential policyholder). So, article 53(1)2 will not apply where advice is given to persons who receive it as:(1) an adviser who will use it only to inform advice they give3 to others; or(2) a journalist or broadcaster who will use it only for journalistic purposes
Advice will still be covered by article 53(1)2 even though it may not be given to any particular policyholder (for example, advice given in a periodical publication or on a website). Such advice would, however, be unlikely to be a personal recommendation (see PERG 5.8.3AG, PERG 8.24.1G and PERG 8.30BG).3
Discussions with the appropriate regulator8 are particularly relevant where the firm has to discharge obligations to its customers or policyholders before it can cease carrying on a regulated activity. This may be the case, for example, where the firm is an insurer, a bank a dormant account fund operator,4 or, as is often the case, holding client money or customer assets.8
Before a general insurance contract is concluded, a firm must inform a customer who is a natural person of:(1) the law applicable to the contract where the parties do not have a free choice, or the fact that the parties are free to choose the law applicable and, in the latter case, the law the firm proposes to choose; and(2) the arrangements for handling policyholders’ complaints concerning contracts including, where appropriate, the existence of a complaints body (usually the
For life insurance policies pledged to a lending firm to be recognised the following conditions must be met:(1) the party providing the life insurance must be subject to the Solvency II Directive2, or is subject to supervision by a competent authority of a third country which applies supervisory and regulatory arrangements at least equivalent to those applied in the Community;112(2) the life insurance policy is openly pledged or assigned to the lending firm;(3) the party providing
In CONC 2.5.8R (14):(1) payment protection product means a product or feature of a product designed to offer customers short-term protection against potential loss of income, by providing the means for them to meet (or temporarily suspend) their financial obligations including repayments under a credit agreement. Payment protection products include, in particular, short term income protection, debt freeze or debt waiver;(2) short-term income protection means a contract of insurance
The information provided to the 2FCA2by the Society under INSPRU 8.2.25 R must include:(1) a statement of the purpose of any proposed amendment or new Lloyd's trust deed and the expected impact, if any, on policyholders, managing agents, members, and potential members; and(2) a description of the consultation undertaken under INSPRU 8.2.26 R including a summary of any significant responses to that consultation.
(1) 1For the purposes of the rules on permitted links, a stock lending transaction (including a repo transaction) is approved if:(a) the assets lent are permitted links;(b) the counterparty is an authorised person, an approved counterparty, a person registered as a broker-dealer with the Securities and Exchange Commission of the United States of America or a bank, or a branch of a bank, supervised, and authorised to deal in investments as principal, with respect to OTC derivatives