Insurance Act 2015

13 Remedies for fraudulent claims: group insurance

(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.