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Home/Law/You are a claims handler for an insurer. You have received a claim from one of the insurer’s policyholders, ABC Ltd, a bus company. One of ABC Ltd’s buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B.

You are a claims handler for an insurer. You have received a claim from one of the insurer’s policyholders, ABC Ltd, a bus company. One of ABC Ltd’s buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B.

In each of the recovery methods, the burden of proof is on the insurer. In both instances, the insurer has to prove that the claims made stem from the fraudulent actions of pedestrians A and B. In the first method of recovery, under the Proceeds of Crime Act 2002, the insurer has to prove in a court of law that the pedestrians received compensation for their injuries unjustifiably by exaggerating their claims. The court of law is required to assess the evidence and give a verdict. If convicted, there is proof that falsified claims have been made, thereby necessitating recovery.

The main point of contention to explore in such cases is the burden of proof that insurers have to meet in demonstrating that, without the erroneous pieces of information given, they would have taken a different course of action. In other words, they need to prove what they would have done differently in a factual situation – a feat that remains largely hypothetical. Nonetheless, courts are aware of the tendency of insurers to think of best-case scenarios in arguing their cases of innocent misrepresentation, so a higher standard of proof is bestowed on firms to prove that this type of misrepresentation was injurious to them.

In the second recovery method, under first-party claims, the law limits the rights of the insurer to obtain compensation for receiving and relying on wrongful data. Therefore, the main precondition that needs to be satisfied before an insured escapes liability is when it can be proved that their use of the erroneous information would have prevented them from receiving compensation in the first place. Alternatively, insurers would have to prove that the information obtained would have led them to refrain from making the payments. Overall, insurers are often encouraged to have effective underwriting guidelines that address cases of misrepresentation of facts and nurture a culture of discipline to settle insurance claims amicably.

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Academic.Tips. (2022) 'You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B'. 9 October.

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Academic.Tips. (2022, October 9). You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B. https://academic.tips/question/you-are-a-claims-handler-for-an-insurer-you-have-received-a-claim-from-one-of-the-insurers-policyholders-abc-ltd-a-bus-company-one-of-abc-ltds-buses-was-involved-in-an-incident-which-resulted-3/

References

Academic.Tips. 2022. "You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B." October 9, 2022. https://academic.tips/question/you-are-a-claims-handler-for-an-insurer-you-have-received-a-claim-from-one-of-the-insurers-policyholders-abc-ltd-a-bus-company-one-of-abc-ltds-buses-was-involved-in-an-incident-which-resulted-3/.

1. Academic.Tips. "You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B." October 9, 2022. https://academic.tips/question/you-are-a-claims-handler-for-an-insurer-you-have-received-a-claim-from-one-of-the-insurers-policyholders-abc-ltd-a-bus-company-one-of-abc-ltds-buses-was-involved-in-an-incident-which-resulted-3/.


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Academic.Tips. "You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B." October 9, 2022. https://academic.tips/question/you-are-a-claims-handler-for-an-insurer-you-have-received-a-claim-from-one-of-the-insurers-policyholders-abc-ltd-a-bus-company-one-of-abc-ltds-buses-was-involved-in-an-incident-which-resulted-3/.

Work Cited

"You are a claims handler for an insurer. You have received a claim from one of the insurer's policyholders, ABC Ltd, a bus company. One of ABC Ltd's buses was involved in an incident which resulted in serious injuries to two pedestrians. The whole incident was caught on closed-circuit television (CCTV) cameras and the policyholder has accepted full liability. Pedestrian A claimed for loss of earnings, for a six-month period, due to reduced mobility as a result of the incident. Pedestrian B claimed for loss of earnings . Payments have been made to both pedestrians in full settlement of these claims. Subsequently, you have established that: Pedestrian A had been playing golf with no apparent mobility issues, during the period for which they claimed. Pedestrian B presented fake payslips in support of their claim. Pedestrian B has since moved overseas to another country. You are now seeking to obtain recoveries from pedestrian A and pedetrian B. Identify, with justification, the burden and standard of proof for each method of recovery available to the insurer for the claims payment paid to pedestrians A and B." Academic.Tips, 9 Oct. 2022, academic.tips/question/you-are-a-claims-handler-for-an-insurer-you-have-received-a-claim-from-one-of-the-insurers-policyholders-abc-ltd-a-bus-company-one-of-abc-ltds-buses-was-involved-in-an-incident-which-resulted-3/.

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