Question ID: 1924
Regulation Reference: (EU) No 2016/97 - Insurance Distribution Directive
Topic: Definitions (Art. 2 IDD)
Date of submission: 20 Aug 2021
Can EIOPA please provide further clarity as to what constitutes the 'expert appraisal of claims' under the IDD?
Recital 14 of the references that the IDD does not apply to, inter alia, the expert appraisal of claims, however it is unclear what is intended to be excluded by expert appraisal of claims under the directive and how this activity falls outside the definition of insurance distribution under the IDD.
Background of the question
Any assistance in this regard would be greatly appreciated.
Please find below the answer to your question which you submitted on 14 May 2019 regarding the understanding of “expert appraisal of claims” as laid down in Art. 2 (2) letter b of the Insurance Distribution Directive (IDD).
Art. 2 (2) letter b of the IDD defines activities which shall not be considered to constitute insurance distribution activities, including the management of claims of an insurance undertaking on a professional basis and expert appraisal of claims. Further guidance can be found in Recital 14 of the IDD stating that the Directive should not apply to persons with another professional activity, such as tax experts, accountants and lawyers who provide advice on insurance cover on an incidental basis in the course of that other professional activity … provided that the purpose of this activity is not to help the customer conclude or fulfil an insurance contract.
Against this background it can be concluded that assessment of claims undertaken by a professional expert on behalf of an insurance undertaking falls outside the scope of the IDD. This applies, for example, in instances where an insurance undertaking has outsourced the claim appraisal process to an external entity. The same applies if the appraisal is undertaken by a person acting on behalf of a customer, whereas here the IDD requires that the appraisal occurs in the context of another professional activity, e.g. tax consultant or lawyer. However, if the claim appraisal is part of providing assistance to a customer in the contract performance, the scope of the IDD is given (Art. 2 (2) letter a IDD).