AIC 30 | 151 Questions and Answers(A+ Solution guide)

First Party Focus - Coverage and Amount of damage Second Party - Insurance Company First Party - Insured Third Party - Claimant Third Party Focus - Liability, Coverage, and Amount of damage Third Party Administrator (TPA) - an organization that provides admin services associated with risk financing and insurance. They handle claims and risk management for self-insured organizations Independent Adjuster - handles claims for the insurer for a fee. Works for the insurer Public Adjuster - an outside organization that is hired by the insured to represent the insured in the claim for a fee. Works for the public Quantitative Measures - can have actual numbers assigned, such as number of claims opened and percentage of subrogation recovery Qualitative Measures - related to intangible measures. nothing concrete, did they do a good job? do they have good negotiation skills? Ethics - the study of what constitutes good and bad behavior, dealing with the moral duty and obligationConflict of Interest - a 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 - contracts 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 - an intentional misrepresentation resulting in harm to another person or organization Code of Ethics - professional guidelines of behavior within an organization or profession N.A.I.C - The National Association of Insurance Commissioners Model Laws - NAIC develops that they feel is an appropriate law related to insurance/risk management Model Laws - Goal - to standardize the laws related to insurance, to address issues related to insurance Unfair Claims Settlement Practice Act - to prevent insurance companies from taking unfair advantage of the insured/claimants Reservations of Rights Letter - an 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.