AE21 Section 1: The Role of an Adjuster & The Art and Practice of Adjusting |
Complete Study Guide with Practice Questions and Verified Answers
1. claim: assertion of an alleged legal right against a person, entity, company or insurer that carries with it a
demand for relief
2. assertion: can be a request, demand, letter requesting action, or bill requesting payment
3. alleged: the claim may or may not be valid i.e. there may not be any legal right for relief
4. relief: Usually compensation or payment. Can also mean restitution, return, recovery, or replacement of either
property or money
5. first-party claim: a claim by a policyholder against their own insurer for recovery under the policy/contract
held, and for which premium has been paid
6. third-party claim: a claim made by a third party against an insured
7. business day: a day other than Saturday, Sunday or a holiday recognized by the stat
8. claimant: any person maкing a claim
9. notice of claim: any written notification provided by the claimant to the insurer that reasonably apprises
the insurer of the facts related to the claim
10. Texas considers conducting insurance business to include: - soliciting insurance
- binding, underwriting and sale of insurance
- and adjusting of claims
11. What are a carrier's claim handling goals?: 1. Help with losses / injs covered by the policy
contract
2. Minimize loss for insrd and carrier - fairly evaluate the legitimacy of the claim and value
3. Comply & pay claims
4. Maintain friendly relations with insrd
5. Satisfy company's moral and ethical obligations
12. adjuster: an individual who investigates and settles claims arising under property, casualty or surety contracts
on behalf of either the insrd or insurer
Worкs on compensation, fee or commission
13. adjusting a claim: the process of investigating, evaluating, reporting on, negotiating, and resolving claims
under a policy
14. Health insurance claims handlers are , not adjusters because they
pay according to a rate plan or schedule: processors
15. Name the 3 types of adjusters: 1. company/statt adjusters
2. independent adjusters - usually self-employed
3. public adjusters - represent the insured
1/2
Complete Study Guide with Practice Questions and Verified Answers
1. claim: assertion of an alleged legal right against a person, entity, company or insurer that carries with it a
demand for relief
2. assertion: can be a request, demand, letter requesting action, or bill requesting payment
3. alleged: the claim may or may not be valid i.e. there may not be any legal right for relief
4. relief: Usually compensation or payment. Can also mean restitution, return, recovery, or replacement of either
property or money
5. first-party claim: a claim by a policyholder against their own insurer for recovery under the policy/contract
held, and for which premium has been paid
6. third-party claim: a claim made by a third party against an insured
7. business day: a day other than Saturday, Sunday or a holiday recognized by the stat
8. claimant: any person maкing a claim
9. notice of claim: any written notification provided by the claimant to the insurer that reasonably apprises
the insurer of the facts related to the claim
10. Texas considers conducting insurance business to include: - soliciting insurance
- binding, underwriting and sale of insurance
- and adjusting of claims
11. What are a carrier's claim handling goals?: 1. Help with losses / injs covered by the policy
contract
2. Minimize loss for insrd and carrier - fairly evaluate the legitimacy of the claim and value
3. Comply & pay claims
4. Maintain friendly relations with insrd
5. Satisfy company's moral and ethical obligations
12. adjuster: an individual who investigates and settles claims arising under property, casualty or surety contracts
on behalf of either the insrd or insurer
Worкs on compensation, fee or commission
13. adjusting a claim: the process of investigating, evaluating, reporting on, negotiating, and resolving claims
under a policy
14. Health insurance claims handlers are , not adjusters because they
pay according to a rate plan or schedule: processors
15. Name the 3 types of adjusters: 1. company/statt adjusters
2. independent adjusters - usually self-employed
3. public adjusters - represent the insured
1/2
