NC CLAIMS ADJUSTER LATEST 2026 TESTS PAPER
QUESTIONS AND SOLUTIONS RATED A+
✔✔Public Adjuster - ✔✔● Hired by policyholder (the claimant)
● Represents the policyholder in the claim
● Charges a commission, usually about 10% of settlement
● Hired when the insured knows the insurer will be making a payment for the claim
● Helps determine the proper identification and valuation of a loss
● Specializes in appraising and negotiating claims
✔✔Emergency Adjuster - ✔✔*temporarily licensed by insurance commissioner when
there is a catastrophe
*may be adjusters from other states
*may be an individual who is temporarily certified by an insurer to adjust claims
*only allowed to work on claims related to the disaster.
✔✔3 Responsibilities of an Insurance Adjuster - ✔✔1. Acts as the Fiduciary Agent: This
means that, when handling claims, the adjuster is responsible for making decisions in
place of the insurer and for the insurer's benefit.
2. Has the Power to Bind to the insurer
3. Must Report to the Principal (insurer)
✔✔Essential Elements of a Loss Report - ✔✔● Policy Start and Stop dates
● Date of the occurrence, or loss
● Identification of all parties involved in the claim
● Full description of the loss
● Tort and tortfeasors (if applicable)
● Policy form and policy number
● Policy coverages
● Policy deductibles
✔✔Initial Report - ✔✔Also called the "field report"
• Often required after 15 days
• Time-lines and deadlines (expediency issues)
• Apparent losses
• Liability issues (when known)
• Applicable coverages
• Initial claim reserve
✔✔Initial Claim Reserve - ✔✔A claim reserve is the amount of money that the insurer
sets aside in preparation for paying the claim.
✔✔Interim (a.k.a. Status) Report - ✔✔• Update on claim progress
• Due at set intervals as long as a claim is open
• New evidence (depositions, statements)
, • Medical information
• Repair estimates
✔✔Final (a.k.a. Full) Report - ✔✔• all facts & evidence of the claim
• policy coverage's applied
• adjusted losses
• final claim disposition
✔✔Steps of the Claims Process - ✔✔1. Acknowledge the claim
2. Establish lines of communication
3. Prepare necessary paperwork
4. Determine insurer's liability in the claim
5. Investigate the losses
6. Determine the time and cost of repairs
7. Apply all policy coverages and provisions
8. Negotiate a settlement
9. Prepare final reports
✔✔Determining Insurer's Liability - ✔✔A.I.T.P.H.A.C
● Was the policy active at the time of loss?
● Does the claimant have insurable interest?
○ do any other parties have insurable interest (mortgage company, etc.)?
● Does the policy cover the type of damage or injury being claimed?
○ does the policy cover the proximate cause of the loss?
● Is there a history of similar claims? If so, have they reduced the policy limit
available for this loss?
● Will any other policies cover this loss?
● Has the insured met all requirements of the contract?
○ if covered, move on to next step
○ if NOT covered, deny the claim with a full explanation
✔✔Investigate a Property Claim - ✔✔● Inspect damages
● Take photos
● Interview claimant and witnesses
● Review police report
● Consult with professionals
✔✔Qualify the Settlement - ✔✔The adjuster must qualify the settlement:
● Explain the reasons for the settlement amount
● Step-by-step justification for decision
✔✔Prepare Final Adjustment Reports - ✔✔● Provide final settlement documents to
claimant
● Explain settlement documents
● Inform claimant of repair deadlines
● Explain depreciation recovery (if applicable)
QUESTIONS AND SOLUTIONS RATED A+
✔✔Public Adjuster - ✔✔● Hired by policyholder (the claimant)
● Represents the policyholder in the claim
● Charges a commission, usually about 10% of settlement
● Hired when the insured knows the insurer will be making a payment for the claim
● Helps determine the proper identification and valuation of a loss
● Specializes in appraising and negotiating claims
✔✔Emergency Adjuster - ✔✔*temporarily licensed by insurance commissioner when
there is a catastrophe
*may be adjusters from other states
*may be an individual who is temporarily certified by an insurer to adjust claims
*only allowed to work on claims related to the disaster.
✔✔3 Responsibilities of an Insurance Adjuster - ✔✔1. Acts as the Fiduciary Agent: This
means that, when handling claims, the adjuster is responsible for making decisions in
place of the insurer and for the insurer's benefit.
2. Has the Power to Bind to the insurer
3. Must Report to the Principal (insurer)
✔✔Essential Elements of a Loss Report - ✔✔● Policy Start and Stop dates
● Date of the occurrence, or loss
● Identification of all parties involved in the claim
● Full description of the loss
● Tort and tortfeasors (if applicable)
● Policy form and policy number
● Policy coverages
● Policy deductibles
✔✔Initial Report - ✔✔Also called the "field report"
• Often required after 15 days
• Time-lines and deadlines (expediency issues)
• Apparent losses
• Liability issues (when known)
• Applicable coverages
• Initial claim reserve
✔✔Initial Claim Reserve - ✔✔A claim reserve is the amount of money that the insurer
sets aside in preparation for paying the claim.
✔✔Interim (a.k.a. Status) Report - ✔✔• Update on claim progress
• Due at set intervals as long as a claim is open
• New evidence (depositions, statements)
, • Medical information
• Repair estimates
✔✔Final (a.k.a. Full) Report - ✔✔• all facts & evidence of the claim
• policy coverage's applied
• adjusted losses
• final claim disposition
✔✔Steps of the Claims Process - ✔✔1. Acknowledge the claim
2. Establish lines of communication
3. Prepare necessary paperwork
4. Determine insurer's liability in the claim
5. Investigate the losses
6. Determine the time and cost of repairs
7. Apply all policy coverages and provisions
8. Negotiate a settlement
9. Prepare final reports
✔✔Determining Insurer's Liability - ✔✔A.I.T.P.H.A.C
● Was the policy active at the time of loss?
● Does the claimant have insurable interest?
○ do any other parties have insurable interest (mortgage company, etc.)?
● Does the policy cover the type of damage or injury being claimed?
○ does the policy cover the proximate cause of the loss?
● Is there a history of similar claims? If so, have they reduced the policy limit
available for this loss?
● Will any other policies cover this loss?
● Has the insured met all requirements of the contract?
○ if covered, move on to next step
○ if NOT covered, deny the claim with a full explanation
✔✔Investigate a Property Claim - ✔✔● Inspect damages
● Take photos
● Interview claimant and witnesses
● Review police report
● Consult with professionals
✔✔Qualify the Settlement - ✔✔The adjuster must qualify the settlement:
● Explain the reasons for the settlement amount
● Step-by-step justification for decision
✔✔Prepare Final Adjustment Reports - ✔✔● Provide final settlement documents to
claimant
● Explain settlement documents
● Inform claimant of repair deadlines
● Explain depreciation recovery (if applicable)
