Chapter 16 - Insurance Claims Adjusting with 100% correct answers

An "insurance claim" is a 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 first 00:04 01:33 A "_____" party claim is made against an insured who is covered by a liability policy, such as Commercial General Liability or Malpractice insurance policies third Claims Adjusters 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 independent adjusters "public adjusters Independent Adjuster - 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 "Property & Casualty Adjuster", "General Lines Adjuster" or "All Lines Adjuster" Public Adjuster - A public adjuster is an 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 liability property insurance Regulation of Public Adjusters 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. bond bond State laws dictate that there must be a __________ between the public adjuster and the insured 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. rescind the contract within a specified number of days Fiduciary Responsibilities of the Adjuster As a "____", an adjuster must represent the interests of "_____" fiduciary agent the principal An independent adjuster acts as a fiduciary agent to the _____, therefore the principal in this case, is the ______. 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. unauthorized practice 1. The adjuster may provide the information that was gained through the claims investigation, to the principal, but cannot _________. The adjuster may attempt to settle the claim, but only at the monetary value the principal is willing to pay, or to accept. legally advise the principal as to how the claim should be settled 2. The adjuster may express an opinion on the extent of damage or injury, and the monetary value of the investigated claim, ________ but only as part of a factual analysis. 3. The adjuster must manage claims in _________, including the state's adopted Unfair Claim Settlement Practices. compliance with all state laws and regulations 4. The adjuster may properly secure factual data and transmit settlement offers made on behalf of the principal, but only when ___________. May also assist in the ________ for his or her principal. acting with the consent of the lawyers for both the plaintiff and defendant negotiations for settlement with the approval of the lawyer