PART 4

Fraudulent claims

Remedies for fraudulent claims: group insurance
13
1
This section applies where—
a
a contract of insurance is entered into with an insurer by a person (“A”),
b
the contract provides cover for one or more other persons who are not parties to the contract (“the Cs”), whether or not it also provides cover of any kind for A or another insured party, and
c
a fraudulent claim is made under the contract by or on behalf of one of the Cs (“CF”).
2
Section 12 applies in relation to the claim as if the cover provided for CF were provided under an individual insurance contract between the insurer and CF as the insured; and, accordingly—
a
the insurer's rights under section 12 are exercisable only in relation to the cover provided for CF, and
b
the exercise of any of those rights does not affect the cover provided under the contract for anyone else.
3
In its application by virtue of subsection (2), section 12 is subject to the following particular modifications—
a
the first reference to “the insured” in subsection (1)(b) of that section, in respect of any particular sum paid by the insurer, is to whichever of A and CF the insurer paid the sum to; but if a sum was paid to A and passed on by A to CF, the reference is to CF,
b
the second reference to “the insured” in subsection (1)(b) is to A or CF,
c
the reference to “the insured” in subsection (1)(c) is to both CF and A,
d
the reference in subsection (2)(b) to the premiums paid under the contract is to premiums paid in respect of the cover for CF.