AINS 21 Segment B (Chapters 4-6) Rated A+
AINS 21 Segment B (Chapters 4-6) Rated A+ claim a demand by a person or business seeking to recover from an insurer for a loss that may be covered by an insurance policy claimant anyone who submits a claim to an insurer first party the insured in an insurance contract third party a person or business who is not a party to the insurance contract bu who asserts a claim against the insured claim representative (or adjuster) a person responsible for verifying coverage, determining the cause of loss, determining the amount of damages or extent of loss, and settling or otherwise concluding a claim types of adjusters staff claim representatives (inside and outside); independent adjusters; producers; public adjusters staff claim representative an insurer employee who performs some or all of the insurer's claim handling activities inside claim representative an insurer employee who handles claims that can be settled by phone, mail, or email from inside the insurer's office outside (or field) claim representative an insurer employee who handles claims that cannot be handled easily by phone, mail, or email independent adjuster a claim representative who offers claim handling services to insurers for a fee settlement authority authority expressly given to a producer by an insurer to settle and pay certain types of claims up to a specified limit public adjuster a person hired by an insured to represent the insured in handling a claim self-insurance plan an arrangement in which an organization pays for its losses with its own resources rather than by purchasing insurance third-party administrator (TPA) an organization that contracts to provide administrative services, including claim handling, to other businesses steps in claim handling verifying coverage; determining the cause of loss; determining the amount of damages or extent of loss; negotiating and settling (or denying) the claim reservation of rights letter a notice sent by the insurer advising the insured that the insurer is proceeding with a claim investigation but that the insurer retains its right to deny coverage later coverage questions for property claims does the insured have an insurable interest in the property; is the damaged property covered by the policy; is the cause of loss covered by the policy; do any additional coverages, endorsements, or coverage limitations apply insurable interest a coverage verification criterion that exists when a person or other entity would suffer a financial loss if the subject property were damaged property valuation methods actual cash value; replacement cost; agreed value actual cash value (ACV) the cost to replace property minus an allowance for the property's depreciation depreciation the allowance for physical
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