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CLAIM PROCEDURES AND DOCUMENTATIONS - Coggle Diagram
CLAIM PROCEDURES AND DOCUMENTATIONS
FUNCTION
indemnify the insured for covered loss.
PURPOSE
Minimizing the cost of claims
Complying with contractual promises
BEFORE CLAIM PAID
SATISFIED
The insurer must be told
Proof must be furnished
A loss or insured event must occur
The claim must be legal
The insurance contract must be enforceable
The policy must cover the appropriate type and cause of loss
The size of the claim must be decided
NOTIFICATION
Good reason early notification
Insurers may have to advise their re-insurers
Delay may effect property
Delay can effect investigation
renewal terms may be affected in some way
PROF OF LOSS
BASIS OF LOSS
Onus Of Proof
task or duty imposed on someone to produce evidence to prove that what he has stated or affirmed is true
Proof that an insured peril arose
Proof of the amount of loss
REASON CLAIM FAIL
insurance contract is invalid
contract wording, or the agreement between insurer and insured, deliberately excludes such losses
claim is contrary to public policy
DUTIES OF INSURED
Express duties
Implied duties