820 Syl
820 Syl
820 Syl
INSURANCE INSTITUTE
820
Claims management (non-life)
Objective: To develop in the candidate:
• a knowledge and understanding of claims philosophies;
• a knowledge and understanding of the implementation of claims systems;
• a knowledge and understanding of the management of claims functions, and the management
of the claims service;
• a knowledge and understanding of claims practice within the non-life insurance industry;
• the ability to apply knowledge and skills to practical situations;
• the ability to synthesise different aspects of the syllabus and apply them to given scenarios.
Assumed knowledge and application skills: 1.4 European Union influence
Assumed knowledge may not appear in the course text but Candidates should be able to
forms part of the syllabus and thus may be examined. It is – discuss the influence of the European Union on UK
assumed the student has a thorough understanding of claims claims procedures.
practice and processes as they relate to non-life business. Also
the subject matter covered in unit IF4 Insurance claims handling 1.5 Scale of claims events
process or equivalent qualification.
Candidates should be able to
Method of assessment: See page 7 in the 2005 Advanced
Diploma in Insurance ‘Information for candidates’ brochure. – explain the main types of claims events.
Notes:
– The syllabus will be based on UK law and practice.
2. Claims service management
– The April session will test the legal position as of 31st 2.1 Customer expectations
August of the preceding year. Candidates should be able to
– The October session will test the legal position as of 28th – discuss the management of customer expectation within
February of the same year. the claims function;
– explain the influence of customer expectations on the
1. The claims environment design of claims systems.
2005 1 of 3
© The Chartered Insurance Institute 2004
2.6 Court awards 3.9 Reinsurance
Candidates should be able to Candidates should be able to
– outline the trends in arbitration and court awards and – discuss claims considerations relating to reinsurance
their impact on claims management. with particular reference to:
• notification conditions;
2.7 Varying requirements
• accumulations.
Candidates should be able to
– discuss the variations in the requirements of ‘personal’
and ‘commercial’ policyholders and their representatives; 4. Claims management in practice
– discuss the variations in the requirements of own clients
4.1 Claims handling operation
and third party claimants and their representatives.
Candidates should be able to
– outline the different strategic roles of the claims
3. Claims technical management manager/director and claims adjusters/claims handlers;
– discuss how a claims manager manages the
3.1 Design & implementation of claims handling procedures
work of an external holder of delegated
Candidates should be able to authority, including:
– explain the integration of the claims function in the overall • work processes;
organisational structure;
• information flows;
– explain the features, structure and objectives of different
• scope of authority;
claims procedures in relation to;
• potential for abuse.
• personal claims;
• commercial claims. 4.2 Catastrophe management
Candidates should be able to
3.2 Outsourcing
– explain the nature of catastrophe management
Candidates should be able to
and resourcing.
– discuss the considerations relating to outsourcing with
particular reference to; 4.3 Protocols
• available skill levels; Candidates should be able to
• selection criteria; – discuss the establishment of protocols in relation to
• costs. • service delivery standards;
• service provider fees/charges;
3.3 Volume complexity
• claims estimating;
Candidates should be able to
• internal ‘benchmarking’.
– discuss the resource implications of volume and
complexity of business being transacted to the
claims system. 4.4 Supplier/relationship management
Candidates should be able to
3.4 Information technology – outline the need for monitoring and updating of
Candidates should be able to agreements with suppliers.
– discuss the role of information technology in
claims management; 4.5 Helplines
– outline the use of management information generated by Candidates should be able to
information technology. – discuss the role and benefits of ‘help lines’ as part of the
wider claims management process.
3.5 Fraudulent claims
Candidates should be able to 4.6 Market practice
– discuss the identification and treatment of Candidates should be able to
fraudulent claims; – discuss the practical implications of differences in global
– explain the significance and use of CUE and other and local market practice on:
databases in the claims function. • regulations and legislation;
• currency and taxation;
3.6 Ethical aspects • economic conditions.
Candidates should be able to
– discuss the ethical aspects of settling legitimate claims
and of challenging dubious claims. 5. Cost management
3.7 Delegated authority 5.1 Cost control
Candidates should be able to Candidates should be able to
– explain the use of delegated claims settling authority. – describe the issues and methods of managing the cost
of the claims operation.
3.8 Litigation
5.2 Strategy
Candidates should be able to
Candidates should be able to
– explain the role of legal experts in claims negotiation;
– discuss the financial impact of claims
– explain the main procedural aspects of litigation with management strategy.
particular reference to claims handling philosophy.
2005 2 of 3
© The Chartered Insurance Institute 2004
5.3 Estimating and reserving Note: The examination will test the syllabus alone. The reading
Candidates should be able to list is provided for guidance only and is not in itself the subject
of the examination.
– discuss estimating and reserving policies and their
implications for the claims function. Most of these additional study materials can be borrowed or
purchased from CII Information Services at www.cii.co.uk/is
5.4 Claims and underwriting
Candidates should be able to Primary text
– discuss the impact of claims on underwriting and pricing. Claims management (non-life). London: The CII.
Coursebook 820.
5.5 Actuarial reviews
Candidates should be able to
Additional reading
– explain the importance of actuarial reviews in monitoring Controls over procedures for establishing general insurance
financial performance. business technical provisions: Guidance note for insurance
companies. London: Association of British Insurers, 1996.
5.6 Leakage
Fraudulent claims, Ian Youngman. London. CII Information
Candidates should be able to Services. Online document available to CII members only.
– describe the identification of sources of ‘leakage’ Updated. www.cii.co.uk/is/factfiles
including tracing of insurers and effecting recoveries
in run-off;
– explain the methods of minimising leakage.
Periodicals
The Journal. The CII. Six issues a year. Also available online
(CII/SOFA members only) at www.cii.co.uk/is
6. Quality management Post Magazine. London: Timothy Benn Publishing. Weekly.
6.2 Audits
Examination guides
Candidates should be able to
You are strongly advised to study these before the examination.
– explain the value of audits of: Please visit www.cii.co.uk to buy online or contact CII Customer
• own staff; Service for further information on 020 8989 8464.
• suppliers of services.
Exam technique/study skills
Reading list There are many modestly priced guides available in bookshops.
The following list provides details of various publications which You should choose one which suits your requirements.
may assist with your studies. The primary text for this syllabus An example is:
is shown in bold type. Periodicals and publications listed as The exam secret: how to make the grade. Barbara Brown.
additional reading will be of value in ensuring candidates keep Tadworth, Surrey: Elliott Right Way Books, 2000.
up to date with developments and in providing a wider coverage For a more interactive approach, you should consider:
of syllabus topics. Any reference materials cited are
authoritative, detailed works, which should be used selectively Winning the brain game. London: The CII, 1996. CD Rom.
as and when required.
2005 3 of 3
© The Chartered Insurance Institute 2004