Chapter 1 Principles of Law
1.1 Sources of Law
1.2 Principles of General Contract Law
Chapter 2 The Parties
2.1 The Policyholder
2.2 Insurance Companies
2.3 Lloyd's of London
2.4 Co-Insurers
2.5 Reinsurers
2.6 Insurance Brokers/Intermediaries
2.7 Underwriting Agencies
2.8 The Financial Services Authority (FSA)
2.9 Financial Ombudsman Service (FOS)
2.10 Loss Adjusters
2.11 Loss Assessors
2.12 Lawyers
2.13 Supply Chain
Chapter 3 The Contract of Insurance
3.1 The Prospectus
3.2 The Proposal Form
3.3 The Schedule of Insurance
3.4 The Policy of Insurance
3.5 Practical Tips on Dealing with Exclusions and Breaches of Warranty and Condition
3.6 Customer Care and Complaints
Chapter 4 Insurable Interest and Indemnity
4.1 The Creation of Insurable Interest as a Statutory Requirement
4.2 The Indemnity Principle
4.3 Legislative History
4.4 Situations Where the Interests of More than One Party are Affected
4.5 Indemnity
Chapter 5 Perils
5.1 Fire
5.2 Lightning
5.3 Explosion
5.4 Riot
5.5 Malicious Damage
5.6 Escape of Water
5.7 Escape of Fuel Oil
5.8 Storm
5.9 Flood
5.10 Accidental Damage to Underground Services
5.11 Theft
5.12 Accidental Damage
5.13 Subsidence, Heave and Landslip
Chapter 6 Proximate Clause
6.1 Statute Law
6.2 Operation of the Doctrine
6.3 Ascertaining the Proximate Cause
6.4 Immediate and Intervening Causes
6.5 Concurrent Causes
6.6 Financial Ombudsman Service
6.7 Summary
Chapter 7 Utmost Good Faith
7.1 The Origins of Utmost Good Faith
7.2 Non-Disclosure and Misrepresentation
7.3 Material Facts
7.4 Facts that do not Need to be Disclosed
7.5 Inducement
7.6 Avoidance of the Policy
7.7 Waiver and Estoppel
7.8 Continuation of the Duty of Disclosure after the Policy Incepts
7.9 Approach of the FSA and FOS to Utmost Good Faith
Chapter 8 Fraud
8.1 What is Fraud
8.2 Burden of Proof
8.3 Categories of Fraudulent Claim
8.4 The Effect of Fraud
8.5 Joint and Composite Policies
8.6 The FOS
8.7 Fraud Indicators and their Investigation
Chapter 9 Measures of Settlement
9.1 Policy Limits and Excesses
9.2 Basis of Settlement Provisions
9.3 The Cost of Establishing the Extent of Loss
9.4 Buildings – Measure of Settlement
9.5 Provisional Sums and Prime Cost items
9.6 Public Authorities Clause
9.7 Debris Removal
9.8 Insurers' Right to Reinstate
9.9 Building Repair Networks
9.10 Non-Buildings – Measure of Settlement
9.11 Extended Warranties
9.12 Salvage
9.13 Costs of Mitigation
9.14 Underinsurance
9.15 Day One Basis
9.16 Index Linking
9.17 Penalties for Underinsurance
9.18 Practical Guidance for Calculating the Value at Risk
Chapter 10 Double Insurance and Contribution
10.1 Double Insurance
10.2 Where Double Insurance can Arise
10.3 Restrictions/Limitations on Double Insurance
10.4 Contribution
10.5 Determining the Amount of Contribution
10.6 Authority for Method
10.7 ABI Rules on Contribution
Chapter 11 Subrogation and Distribution of Recoveries
11.1 Subrogation
11.2 Distribution of Recoveries
Chapter 12 Financial Ombudsman Service
12.1 Authority of the Financial Ombudsman Service
12.2 Who is Entitled to Make a Complaint to the FOS
12.3 Complaint Handling Rules
12.4 Time Limits
12.5 Adjudication
12.6 The Loss Adjuster's Role in FOS Investigations
12.7 Decisions Made by the FOS
12.8 Awards
12.9 Compliance with Awards and Settlements
12.10 General Services Provided by the FOS
Chapter 13 The Financial Services Authority
13.1 Role of the FSA
13.2 Regulation of Insurers
13.3 Regulation of Loss Assessors
13.4 Consumer Rights
13.5 Insurance: Conduct of Business Sourcebook
Chapter 14 Reform of Insurance Law
14.1 Background
14.2 Consumer Insurance (Disclosure and Representations) Bill 2009
14.3 Implementation and Future Reform
Chapter 15 Health and Safety and Construction (Design and Management) Regulations 2007
15.1 Health and Safety at Work etc Act 1974
15.2 Management of Health and Safety at Work Regulations 1999
15.3 Risk Assessment
15.4 Construction Projects Subject to the Regulations
15.5 When Duties Arise and Upon Whom
15.6 Duties on a Client
15.7 Duties on a Designer
15.8 Contractor Competency
15.9 Health and Safety Executive (HSE)
Chapter 16 Practical Hints and Tips
16.1 Reporting to Insurers
16.2 Waiver, Estoppel and Reservation of Rights
16.3 Repudiations
16.4 Mitigation of Loss
16.5 Dealing with Policyholders' Claims
16.6 Who Should the Settlement Monies be Paid to?
16.7 Forms of Discharge/Settlement Agreements
16.8 Investigations
16.9 Witness Statements
16.10 Status of Correspondence – Privilege, Without Prejudice and Confidential Communications
Chapter 17 Checklist for Handling Insurance Claims
Fire Loss Adjusters have become Property Adjusters, covers have broadened, and the law has developed. It is therefore time to update and extend John Peverett’s landmark work. It was, in many ways, fitting that Malcolm Hyde should take on this task, for Malcolm began his career with Commercial Union and is now the Executive Director of CILA. This book represents a further 2 years of work by Malcolm in bringing this subject up to date, which was primarily done before he joined the Secretariat of CILA. In this task, Malcolm recognised the substantial benefits of bringing co-authors Brendan McCarthy and James Deacon of Beachcroft LLP to the project.
Beachcroft LLP work closely with the Institute’s Property Special Interest Group and we are especially grateful to them, in particular for their advice on legal issues and case law.
Although this book has been sponsored by CILA, it is not advanced as best practice, nor is it the definitive answer upon any specific subject. Rather, it is a practical handbook for the working adjuster and will, I trust, stand the judgement of those who read it both now and in the future, as did its predecessor volume.
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