In short. The integrated case brings together the earlier modules: separating facts, analysing cover, time limits, the adviser's liability and an action plan for the client.
Learning outcomes
After completing this module you will be able to:
- combine facts, cover and time limits into one timeline;
- justify the evidence needed and the other side's strongest objections;
- prepare a one-page action plan for the client.
Key points
Fact, assumption and missing document
Distinguish confirmed facts, assumptions and missing documents. Every material conclusion must rest on a statutory provision or a policy clause.
Separate cover from liability
Absence or limitation of cover does not automatically prove the broker's liability. Breach of the advice duty, the hypothetical alternative cover and causation must be analysed separately (module 2), as must the time limits of the different claims (module 9).
A one-page claim plan
The claim plan sets out the parties, the timeline, the cover analysis, the other side's objections, the evidence, the first three steps and the facts that would change the preliminary assessment.
Read before the quiz
Articles on this site:
- Typical coverage disputes in cyber, crime and D&O insurance
- Notification and claims strategy across several policies
- Cyber, crime and D&O insurance: interplay and boundaries
- Claims handling practice in Estonia: a guide for TPAs
Legal sources:
Practical case
Write down your own answer before opening the suggested approach.
A company paid EUR 80,000 on a fake invoice. The crime policy's social engineering sub-limit is EUR 25,000; the terms of the cyber policy have not yet been checked. The broker knew of the company's payment risk but did not offer a higher sub-limit. On 1 October the insurer stated in writing that it would pay EUR 25,000 and rejected the rest, stating the consequence of the one-year period for bringing an action. Prepare a claim plan.
Suggested approach
Timeline: payment, discovery, notification of the bank and the insurers, declinature on 1 October; the one-year period for bringing an action runs from receipt of the reply (VÕS § 475(3)). Cover: whether the loss falls under the social engineering cover and whether the sub-limit became part of the contract (VÕS § 37); the cyber policy and overlap of covers (§ 486); compliance with the payment verification condition. Broker: duty (KindlTS § 184(1), § 192(2)(1)), breach (explaining the risk and the sub-limit), whether a higher sub-limit was available at a reasonable price, whether the client would have bought it, and causation (VÕS § 115(1), § 127). The EUR 55,000 difference is not automatically the broker's debt. First steps: collect the policies and correspondence, notify the cyber insurer, diarise the time limit for an action and consider conciliation (check the effect of its rules on the time limit).
Self-check quiz
Answer the three questions and press "Check answers". An explanation is shown for each question.