保险法
保险合同、公平陈述义务、索赔和监管框架。
简介
保险法规范保险人与被保险人之间的合同,包括披露义务和索赔。
In Brief
Insurance law requires the insured to make a fair presentation of all material facts before a commercial policy is entered into (Insurance Act 2015). For consumers, the standard is to take reasonable care not to misrepresent. Insurers must pay valid claims within a reasonable time; delay can itself give rise to a claim for consequential losses.
核心原则
Duty of Fair Presentation — Before a commercial insurance contract is made, the insured must make a fair presentation of the risk to the insurer, disclosing every material circumstance known or which ought to be known (Insurance Act 2015, s.3).
Consumer Disclosure — For consumer insurance, the insured must take reasonable care not to make a misrepresentation (Consumer Insurance Act 2012). The insurer cannot avoid the contract unless the misrepresentation was deliberate or reckless.
Insurable Interest — The insured must have a legally recognised interest in the subject matter of the insurance at the time of loss.
Indemnity — Insurance is a contract of indemnity: the insurer undertakes to compensate the insured for actual loss, not to provide a windfall. Exceptions: life and personal accident insurance.
Subrogation — Once an insurer indemnifies the insured, it is subrogated to the insured's rights against third parties responsible for the loss.
Proximate Cause — The insurer is liable only if the loss was proximately caused by an insured peril. If multiple causes exist, the court determines which is the dominant or effective cause.
Warranties and Conditions — Under the Insurance Act 2015, breach of warranty suspends the insurer's liability rather than discharging it entirely. The insurer's liability is restored when the breach is remedied.
Late Payment — The Insurance Act 2015 (as amended by the Enterprise Act 2016) implies a term that insurers must pay valid claims within a reasonable time. Breach gives rise to a claim for damages.
关键法规
Insurance Act 2015
Consumer Insurance (Disclosure and Representations) Act 2012
重要判例
Carter v Boehm
(1766) 3 Burr 1905
Versloot Dredging v HDI Gerling
[2016] UKSC 45
常见情景
Insurer refuses to pay a valid claim
Under the Insurance Act 2015 (as amended), insurers must pay valid claims within a reasonable time. If they fail, the policyholder can claim damages for late payment, including consequential losses flowing from the delay.
Non-disclosure on a home insurance application
For consumer insurance, the Consumer Insurance Act 2012 applies. The insurer's remedy depends on whether the misrepresentation was deliberate/reckless (contract can be avoided) or careless (proportionate remedy based on what the insurer would have done).
Related Careers
Frequently Asked Questions
What is the duty of fair presentation in insurance?
Under the Insurance Act 2015, commercial policyholders must make a 'fair presentation' of the risk — disclosing every material circumstance known to them or which they ought to know, in a reasonably clear and accessible manner. Failing to comply gives the insurer remedies ranging from reducing the claim proportionately to avoiding the policy entirely (depending on whether the breach was deliberate, reckless, or innocent).
Can an insurer refuse to pay a claim?
An insurer can decline to pay if the claim falls outside the policy coverage, the policyholder breached a policy condition (e.g. failed to notify promptly), there was a material misrepresentation or non-disclosure at inception, or the claim is fraudulent. Under the Insurance Act 2015, an insurer cannot avoid the whole claim for a minor breach of warranty unless the breach increased the risk of the loss.
What is the subrogation principle in insurance?
Subrogation means that once an insurer pays a claim, it steps into the shoes of the insured and can pursue any third party who caused the loss. For example, if your car is damaged by another driver and your insurer pays for repairs, the insurer can recover the cost from the other driver (or their insurer).
How do I dispute an insurance claim decision?
First, complain formally to the insurer in writing, requesting an internal review. If the complaint is not resolved within 8 weeks (or if you receive a final response), you can refer it to the Financial Ombudsman Service (FOS) free of charge. The FOS can award up to £415,000. For commercial insurance disputes, the courts or arbitration may be more appropriate.
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