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(1) sexual or physical abuse
(2) libel, slander and defamation
(3) any claim that could be decided by courts representing jurisdictions outside of England,
Wales, Scotland and Northern Ireland
(4) any claim where we are alleging fraud in the defence of a claim or where there is
evidence of serious organised crime.
(5) any claim involving pollution

the public authority will supply full details of the claim in writing to the insurer together with any
evidence and information that may be required by the insurer for the purpose of investigating or
verifying the claim.

v) it is a condition of this In-House Claims Handling Agreement that

(a) the public authority shall provide to the insurer such information as the insurer requires
about the claims it is handling under this In-House Claims Handling Agreement irrespective
of status on a 6 monthly basis or at any other such time as the insurer shall reasonably
require. Prior to the granting of this In-House Claims Handling Agreement the insurer will
provide the public authority with details in writing of such information it requires in relation
to all claims handled by the public authority;
(b) the insurer or its authorised representatives shall have access to all records and data on
any media relating to any or all claims the public authority is handling under this In-House
Claims Handling Agreement provided that the insurer or its authorised representatives give
no less than seven days’ notice in writing of their intention to access such records and data;
(c) the insurer reserves the right to audit the in house handled files and any associated
operational aspects as required by them;
(d) the insurer reserves the right to take over the handling of any claim where the reporting
criteria identified in iv) above are met.

vi) this In-House Claims Handling Agreement is provided subject to the public authority
maintaining the following:

(a) A team of competent and experienced Claims Handlers with sufficient capacity to maintain
an efficiency of workloads.
(b) Appropriate claims management systems which can achieve the quality of service required,
including staffing numbers.
(c) Robust Claims Management systems which can record the claims management information
in a manner acceptable to us. This means recording the claims records on a ‘policy year
basis’ by coverage and the ability to meet the minimum data return requirements set out
above.

At all times the insurer retains the right to inspect and challenge any of the above aspects.

vii) under no circumstances does this In-House Claims Handling Agreement apply to sub-agents
third party administrators brokers or others without the prior written approval of the insurer.

viii) the insurer reserves the right to withdraw this In-House Claims Handling Agreement by giving no
less than seven days’ notice in writing in the event that:

(a) any of the provisions contained in this In-House Claims Handling Agreement are breached
or
(b) the amount paid with regard to all losses within the retention in respect of the period of
insurance exceeds of any Aggregate Stop Loss shown in the schedule.

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