Chapter 16 - Insurance Claims Adjusting
Exam Questions with correct Answers
2025-2026.
An "insurance claim" is a - ANS-formal request to an insurance company requesting a payment,
based on the terms of an insurance policy (contract).
A "_______" party claim is made by a policyholder, insured, or beneficiary, directly against the
insurance company. They are filed under policies such as Dwelling or Automobile Physical
Damage - ANS-first
A "_____" party claim is made against an insured who is covered by a liability policy, such as
Commercial
General Liability or Malpractice insurance policies - ANS-third
Claims Adjusters - ANS-They inspect and investigate property damage or personal injury
claims to
determine the amount an insurance company is liable to pay for a loss.
Types of Insurance Claims Adjusters - ANS-independent adjusters
"public adjusters
Independent Adjuster - - ANS-works on behalf of an insurance
company and is not permitted to adjust claims on behalf of the individual
policyholder
Name 3 Independent Adjuster titles - ANS-"Property & Casualty Adjuster",
"General Lines Adjuster" or
"All Lines Adjuster"
Public Adjuster -
, A public adjuster is an - ANS-independent contractor representing solely the financial interests
of the insured named in the policy. The insured, and not the insurance company, pays the public
adjuster for his or her services.
State laws prohibit public adjusters from adjusting ________ type claims and restrict their
authority to the adjustment of ________ claims - ANS-liability
property insurance
Regulation of Public Adjusters - ANS-Because public adjusters work directly with the public
without the supervision of an insurance company, state laws regulate the public adjuster more
stringently than independent
adjusters. These additional regulations include:
Most states require a _______ be posted with the Department by anyone who is conducting
business in the state as a public adjuster. This _______would serve as a method to pay
retribution to any policyholder who might be wronged by a public adjuster. - ANS-bond
bond
State laws dictate that there must be a __________ between the public adjuster
and the insured - ANS-written contract
There must be language in the contract indicating that the client can __________ for reasons
such as the insurer promptly paying the claim and eliminating the need for the services of a
public adjuster. - ANS-rescind the contract within a specified number of days
Fiduciary Responsibilities of the Adjuster
As a "____", an adjuster must represent the interests of "_____" - ANS-fiduciary agent
the principal
An independent adjuster acts as a fiduciary agent to the _____, therefore the
principal in this case, is the ______. - ANS-insurer
insurance company.
Relationship to the Legal Profession
A licensed adjuster, while handling claims must be very careful not to drift into an area where
they find themselves engaged in the _________ of law. Specifically, there are six areas in which
the adjuster must carefully act on behalf of his or her principal to avoid engaging
in the unauthorized practice of law. - ANS-unauthorized practice
Exam Questions with correct Answers
2025-2026.
An "insurance claim" is a - ANS-formal request to an insurance company requesting a payment,
based on the terms of an insurance policy (contract).
A "_______" party claim is made by a policyholder, insured, or beneficiary, directly against the
insurance company. They are filed under policies such as Dwelling or Automobile Physical
Damage - ANS-first
A "_____" party claim is made against an insured who is covered by a liability policy, such as
Commercial
General Liability or Malpractice insurance policies - ANS-third
Claims Adjusters - ANS-They inspect and investigate property damage or personal injury
claims to
determine the amount an insurance company is liable to pay for a loss.
Types of Insurance Claims Adjusters - ANS-independent adjusters
"public adjusters
Independent Adjuster - - ANS-works on behalf of an insurance
company and is not permitted to adjust claims on behalf of the individual
policyholder
Name 3 Independent Adjuster titles - ANS-"Property & Casualty Adjuster",
"General Lines Adjuster" or
"All Lines Adjuster"
Public Adjuster -
, A public adjuster is an - ANS-independent contractor representing solely the financial interests
of the insured named in the policy. The insured, and not the insurance company, pays the public
adjuster for his or her services.
State laws prohibit public adjusters from adjusting ________ type claims and restrict their
authority to the adjustment of ________ claims - ANS-liability
property insurance
Regulation of Public Adjusters - ANS-Because public adjusters work directly with the public
without the supervision of an insurance company, state laws regulate the public adjuster more
stringently than independent
adjusters. These additional regulations include:
Most states require a _______ be posted with the Department by anyone who is conducting
business in the state as a public adjuster. This _______would serve as a method to pay
retribution to any policyholder who might be wronged by a public adjuster. - ANS-bond
bond
State laws dictate that there must be a __________ between the public adjuster
and the insured - ANS-written contract
There must be language in the contract indicating that the client can __________ for reasons
such as the insurer promptly paying the claim and eliminating the need for the services of a
public adjuster. - ANS-rescind the contract within a specified number of days
Fiduciary Responsibilities of the Adjuster
As a "____", an adjuster must represent the interests of "_____" - ANS-fiduciary agent
the principal
An independent adjuster acts as a fiduciary agent to the _____, therefore the
principal in this case, is the ______. - ANS-insurer
insurance company.
Relationship to the Legal Profession
A licensed adjuster, while handling claims must be very careful not to drift into an area where
they find themselves engaged in the _________ of law. Specifically, there are six areas in which
the adjuster must carefully act on behalf of his or her principal to avoid engaging
in the unauthorized practice of law. - ANS-unauthorized practice
