C11 - Principles and Practices of Insurance Chapter 11 & 12 Exam | Questions & 100% Correct Answers (Verified) | Latest Update | Grade A+

Two types of losses insurers face : -First party. -Third party. Who is responsible for proving the amount of loss? : it is the insured's responsibility, but if the insurer thinks the amount is out of line then they must prove it. Who reports a loss and to whom do they report it? : A loss may be reported by an insured or third party to a broker/agent or directly to the insurance company. What is the first step an insurer takes concerning a reported loss? : before any action is taken, the coverage must be confirmed by checking the loss details against a hard copy of the policy or on computer screen. 2 | P a g e What is the second step an insurer takes concerning a reported loss? : Once coverage has been confirmed a claim file is opened and a claim number is assigned. What is a proof of loss? : document completed and signed by insureds making claim against their own insurer. Contains details of the policy and the loss, how much is claimed, and to whom it should be paid. Also releases the insurer of further obligations relating to that loss and transfers title to any useful salvage to the insurer. How do insurers determine who investigates a loss? : -decisions depend upon the insurer's policy on the use of adjusters. -some insurers systematically investigate more losses in greater detail than others. What are some subtle ways insureds may perpetrate insurance fraud? : -Overstating settlement values. -claiming for items that never existed.| -Claiming for damage that was never intended to be covered by insurance. What is an estoppel and how can it arise