Insurance Claims Adjusting with correct answers

Insurance claim a formal request to an insurance company requesting a payment, based on the terms of an insurance policy (contract) 00:28 01:34 First-party claim is made by a policyholder, insured, or beneficiary, directly against the insurance company. First-party claims are filed under policies such as Dwelling or Automobile Physical Damage Third-party claim is made against an insured who is covered by a liability policy, such as Commercial General Liability or Malpractice insurance policies. It's important to remember that policies such as Homeowners, Personal Auto, and Business Owners contain both first and third-party coverage What do claims adjusters do? Insurance claims adjusters inspect and investigate property damage or personal injury claims to determine the amount an insurance company is liable to pay for a loss Types of insurance claims adjusters 1. Independent adjusters - they work on behalf of the insurance company 2. Public adjusters - they work on behalf of the policyholders. Both types must be licensed according to the laws of the state in which they are working Are independent adjusters permitted to adjust claims on behalf of the individual policyholder? No How may independent adjusters be hired by an insurance company? 1. "Staff or company" adjuster working in the home office of the insurance company. 2. "Field" adjuster who adjusts claims for an insurer in a particular location. What else can "Staff" adjuster also include and what does that include? Staff adjusters can also include "specialty" adjusters such as workers compensation adjusters, accident & health adjusters, automobile claims adjusters, and other specialties as licensed per state law. What other companies may independent adjusters work for? And what are these adjusters referred as? Adjusting companies that deploy teams of adjusters to work on behalf of an insurer in the case of a catastrophe such as a hurricane, flood, or tornado. These adjusters are referred to as "catastrophe" or "CAT" adjusters What do many states title their adjuster licenses as? And what type of adjusters have these licenses? 1. Property & Casualty Adjuster 2. General Lines Adjuster, or 3. All Lines Adjuster What is a Public adjuster? an independent contractor representing solely the financial interests of the insured named in the policy. 00:00 01:34 Does the insured or the insurance company pay the public adjuster for his or her services? Insured What do state laws prohibit public adjusters from? Adjusting liability type claims and restrict their authority to the adjustment of property insurance claims. In some states, what can individuals hold licenses for concurrently, but not with respect to the same claim? Individuals can hold an independent/staff adjuster license and a public adjuster license concurrently. What do other states prohibit? Other states prohibit an individual form holding both an independent/staff adjuster license and a public adjuster license at the same time, citing a conflict of interest What does it mean if you are a fiduciary agent adjuster? A fiduciary agent adjuster must represent the interest of "the principle". Does an independent adjuster act as a fiduciary agent to the insurer? Yes If an independent adjuster acts as a fiduciary agent to the insurer, who is the principle? The insurance company What happens when the principle is the policyholder? The public adjuster acts as a fiduciary agent with respect to the policyholder What should the adjuster as a fiduciary agent of the principle not do? 1. Not represent interests that are averse to those of the principle 2. The adjuster should not profit, or seek to profit, from any outside source as a consequence of actions for, or on behalf of, the principle