CIPR 6.7.1 Claims handling — general requirements

(1) An authorised firm must have a procedure, recorded in a durable medium, for the effective and proper handling of claims. The procedure must include all the steps from the claim being raised to its settlement.
(2) An authorised firm that handles claims must do so fairly and promptly, and must keep the customer concerned informed about the progress of a claim.
(3) If an authorised firm effects an insurance contract with or for a customer, it must give the customer reasonable guidance in making a claim under the contract, and information about the process. The guidance must not impede a policyholder in making a claim that the policyholder is entitled to make.
(4) A QFC insurer:
(a) must respond promptly to a claim;
(b) must acknowledge the receipt of a claim, and must give notice of any missing information or documents promptly after receiving the relevant claim form;
(c) must not unreasonably reject a claim; and
(d) must keep the policyholder reasonably informed about the progress of the claim.
Guidance

If the investigation of a claim is likely to be protracted, the insurer should give periodic progress or status reports, when appropriate, to the policyholder. The authorised firm should also respond without excessive delay to any reasonable request by the retail customer for information.
(5) The insurer must notify the policyholder in a durable medium of the acceptance or refusal of the claim promptly after completing the investigation.
(6) If a claim is accepted or partly accepted, the notice must set out the settlement amount, how the settlement amount was reached and (if applicable) the reasons why a reduced settlement is offered or any part of the claim is not accepted.
(7) If the claim is denied, the notice must set out the reasons. The insurer must give the policyholder copies of documents or information used in reaching the decision, if the policyholder so requests.
(8) If the policyholder does not accept a settlement offered, the insurer must explain, in a durable medium, the insurer's complaints-handling process and the customer dispute resolution scheme.
(9) A QFC insurer must appoint a registered loss adjuster when necessary, and must notify the policyholder concerned about the appointment (giving the loss adjuster's contact details) within 3 business days.
Derived from QFCRA RM/2019-2 (as from 1st January 2020).