AIC 30
First Party Focus - ANSCoverage and Amount of damage
Second Party - ANSInsurance Company
First Party - ANSInsured
Third Party - ANSClaimant
Third Party Focus - ANSLiability, Coverage, and Amount of damage
Third Party Administrator (TPA) - ANSan organization that provides admin services associated
with risk financing and insurance. They handle claims and risk management for self-insured
organizations
Independent Adjuster - ANShandles claims for the insurer for a fee. Works for the insurer
Public Adjuster - ANSan outside organization that is hired by the insured to represent the
insured in the claim for a fee. Works for the public
Quantitative Measures - ANScan have actual numbers assigned, such as number of claims
opened and percentage of subrogation recovery
Qualitative Measures - ANSrelated to intangible measures. nothing concrete, did they do a good
job? do they have good negotiation skills?
Ethics - ANSthe study of what constitutes good and bad behavior, dealing with the moral duty
and obligation
Conflict of Interest - ANSa situation that occurs when a decision makers personal interests
interfere to the extent that he/she makes decisions that adversely affect the customer, claimant,
or employer
Ex Parte Contract - ANScontracts in which only 1 party is heard. discussing the claim with the
represented person without benefit of their attorney being involved. this is not illegal, but its not
ethical.
Fraud - ANSan intentional misrepresentation resulting in harm to another person or organization
Code of Ethics - ANSprofessional guidelines of behavior within an organization or profession
, N.A.I.C - ANSThe National Association of Insurance Commissioners
Model Laws - ANSNAIC develops that they feel is an appropriate law related to insurance/risk
management
Model Laws - Goal - ANSto standardize the laws related to insurance, to address issues related
to insurance
Unfair Claims Settlement Practice Act - ANSto prevent insurance companies from taking unfair
advantage of the insured/claimants
Reservations of Rights Letter - ANSan insurer's letter that specifies coverage issues and
informs the insured that the insurer is handling a claim with the understanding that the insurer
may later deny coverage should the facts warrant it.
Waiver - ANSthe intentional/unintentional relinquishing (give up) of a known right. (written,
verbally, or by actions taken)
Estoppel - ANSa legal principal that prohibits a party from asserting a claim or a right once it has
been waived and the other party relied upon that information to their detriment.
Non Waiver Agreement - ANSa signed agreement indicating that during the course of the
investigation, neither the insurer nor the insured waives their rights under the policy, the insured
is to sign and return the agreement
Legal Liability - ANSthe legally enforceable obligation for a person or organization to pay a sum
of money (damages) to another person or organization
Statutory Law - ANSthe formal law or statutes enacted by legislative bodies such as congress,
the state legislature, the Senate, or the town council
Negligence - ANSthe failure to exercise due care that a reasonable person would do in a similar
situation to avoid harming others
Four Parts of Negligence - ANS- a duty owed to protect (or not go out of your way to harm)
another party. - a breach of that duty - damage or injury occurs, - the damage or injury was a
direct result of the breach of the duty.
Contributory Negligence - ANSa common-law principal that prevents a person who has been
harmed from recovering damages if that person's own negligence in any way contributed to the
harm
First Party Focus - ANSCoverage and Amount of damage
Second Party - ANSInsurance Company
First Party - ANSInsured
Third Party - ANSClaimant
Third Party Focus - ANSLiability, Coverage, and Amount of damage
Third Party Administrator (TPA) - ANSan organization that provides admin services associated
with risk financing and insurance. They handle claims and risk management for self-insured
organizations
Independent Adjuster - ANShandles claims for the insurer for a fee. Works for the insurer
Public Adjuster - ANSan outside organization that is hired by the insured to represent the
insured in the claim for a fee. Works for the public
Quantitative Measures - ANScan have actual numbers assigned, such as number of claims
opened and percentage of subrogation recovery
Qualitative Measures - ANSrelated to intangible measures. nothing concrete, did they do a good
job? do they have good negotiation skills?
Ethics - ANSthe study of what constitutes good and bad behavior, dealing with the moral duty
and obligation
Conflict of Interest - ANSa situation that occurs when a decision makers personal interests
interfere to the extent that he/she makes decisions that adversely affect the customer, claimant,
or employer
Ex Parte Contract - ANScontracts in which only 1 party is heard. discussing the claim with the
represented person without benefit of their attorney being involved. this is not illegal, but its not
ethical.
Fraud - ANSan intentional misrepresentation resulting in harm to another person or organization
Code of Ethics - ANSprofessional guidelines of behavior within an organization or profession
, N.A.I.C - ANSThe National Association of Insurance Commissioners
Model Laws - ANSNAIC develops that they feel is an appropriate law related to insurance/risk
management
Model Laws - Goal - ANSto standardize the laws related to insurance, to address issues related
to insurance
Unfair Claims Settlement Practice Act - ANSto prevent insurance companies from taking unfair
advantage of the insured/claimants
Reservations of Rights Letter - ANSan insurer's letter that specifies coverage issues and
informs the insured that the insurer is handling a claim with the understanding that the insurer
may later deny coverage should the facts warrant it.
Waiver - ANSthe intentional/unintentional relinquishing (give up) of a known right. (written,
verbally, or by actions taken)
Estoppel - ANSa legal principal that prohibits a party from asserting a claim or a right once it has
been waived and the other party relied upon that information to their detriment.
Non Waiver Agreement - ANSa signed agreement indicating that during the course of the
investigation, neither the insurer nor the insured waives their rights under the policy, the insured
is to sign and return the agreement
Legal Liability - ANSthe legally enforceable obligation for a person or organization to pay a sum
of money (damages) to another person or organization
Statutory Law - ANSthe formal law or statutes enacted by legislative bodies such as congress,
the state legislature, the Senate, or the town council
Negligence - ANSthe failure to exercise due care that a reasonable person would do in a similar
situation to avoid harming others
Four Parts of Negligence - ANS- a duty owed to protect (or not go out of your way to harm)
another party. - a breach of that duty - damage or injury occurs, - the damage or injury was a
direct result of the breach of the duty.
Contributory Negligence - ANSa common-law principal that prevents a person who has been
harmed from recovering damages if that person's own negligence in any way contributed to the
harm
