AIC 30 Latest Update with Verified Solutions

AIC 30 Latest Update with Verified Solutions 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 obligation Conflict 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.