UNIT 21: PRINCIPLES OF CLAIMS ADJUSTING | COMPLETE STUDY GUIDE WITH PRACTICE
QUESTIONS AND VERIFIED ANSWERS
1. First Party Claim: - claim filed under property insurance policy
- the insured files a claim for payment under his own policy, no third party is involved
2. Third Party Claims: Claims filed under liability coverage
- insured = 1st party
- insurance company = 2nd party
- claimant = 3rd party
3. Staff Adjuster: Employee of the insurance company's claim department.
4. Independent Adjusters: hired by insurers to performs all or part of the functions involved in handling
the companies claims
- self employed or worкs for private company
5. public adjusters: -hired by insured
-in exchange for a fee
-if claim is complex or negotiations aren't progressing satisfactorily
-paid fee which is usually % of settlement
6. Documentary Evidence: adjuster's signed and dated reports about actions taкen on the claims and
summaries of phone conversations with the insured or claimant
7. Testimonial evidence: written or recorded statements by individuals who were interviewed by the
adjuster
8. physical evidence: photographs of damaged property or diagrams of an accident scene
9. Reserves: an estimate of the costs associated with a claim
- represents money that is set aside to pay covered claims when they arise
10. Loss Adjustment Expenses: -cost of the loss itself & costs associated with handling the claims
- adjusters salaries and legal expenses related to adjusting the loss
11. Claims handling process: 1. investigation
2. Evaluation
3. disposition (settlement)
12. burden of proof: the obligation to present evidence to support one's claim
13. 3 Steps of Claims Investigation: 1) verify insurance coverage
2) obtain information about the claim
3 verify and compare this information
14. Step 1: Verify Insurance Coverage: - loss must occur during policy period
- loss must occur in coverage territory
1/4
QUESTIONS AND VERIFIED ANSWERS
1. First Party Claim: - claim filed under property insurance policy
- the insured files a claim for payment under his own policy, no third party is involved
2. Third Party Claims: Claims filed under liability coverage
- insured = 1st party
- insurance company = 2nd party
- claimant = 3rd party
3. Staff Adjuster: Employee of the insurance company's claim department.
4. Independent Adjusters: hired by insurers to performs all or part of the functions involved in handling
the companies claims
- self employed or worкs for private company
5. public adjusters: -hired by insured
-in exchange for a fee
-if claim is complex or negotiations aren't progressing satisfactorily
-paid fee which is usually % of settlement
6. Documentary Evidence: adjuster's signed and dated reports about actions taкen on the claims and
summaries of phone conversations with the insured or claimant
7. Testimonial evidence: written or recorded statements by individuals who were interviewed by the
adjuster
8. physical evidence: photographs of damaged property or diagrams of an accident scene
9. Reserves: an estimate of the costs associated with a claim
- represents money that is set aside to pay covered claims when they arise
10. Loss Adjustment Expenses: -cost of the loss itself & costs associated with handling the claims
- adjusters salaries and legal expenses related to adjusting the loss
11. Claims handling process: 1. investigation
2. Evaluation
3. disposition (settlement)
12. burden of proof: the obligation to present evidence to support one's claim
13. 3 Steps of Claims Investigation: 1) verify insurance coverage
2) obtain information about the claim
3 verify and compare this information
14. Step 1: Verify Insurance Coverage: - loss must occur during policy period
- loss must occur in coverage territory
1/4
