N.C. Claims Adjuster EXAM (2025/2026) Updated:
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Terms in this set (329)
an insurance policy covers the insured starting at
Inception/Expiration Date 12:01am on the day on which coverage begins and
expires at 12:01am on the expiration day of the policy.
Occurrence Date Date of which the loss occurred
The loss report should include the names and
Identification of parties addresses of the parties involved in the loss, the
involved names and addresses of any injured person(s) and the
names and addresses of any witness(s).
Identifies the type of coverage purchased (policy
Policy Form/Number form) and the policy number for the particular policy
purchased by the insured.
Information concerning how, when and where the
Description of the Loss accident or loss happened is an essential element in
any loss report.
Shows the type of coverage(s) purchased as well as
Coverage
the limits of coverage purchased.
, Are amounts paid to compensate the plaintiff for
direct expenses such as medical treatment, lost wages
(both past and future), funeral expenses and
Damages - Special
rehabilitation expenses required because of bodily
Compensatory damages
injury. Special damages are paid for losses that can be
determined and documented. They are often referred
to as "out-of-pocket" expenses.
Are paid for losses that cannot be specifically
measured and itemized in order to compensate the
Damages - General
plaintiff for things such as pain and suffering, loss of
Compensatory Damages
the use of an arm or leg, loss of vision, physical
disfigurement and/or loss of consortium.
Are typically awarded to the plaintiff in addition to
compensatory damages when the defendants
Damages - Punitive
conduct has been especially malicious. Punitive
Damages
damages are awarded to punish the defendant and to
deter others from engaging in similar actions.
, 1. Knowingly misrepresenting relevant facts or policy
provisions relating to the coverage at issue. 2. Failing
to acknowledge with reasonable promptness
communications pertaining to claims. 3. Failing to
adopt and implement reasonable standards for the
prompt investigation of claims. 4. Arbitrary and
unreasonable refusal to pay claims. 5. Failing to affirm
or deny coverage of claims within a reasonable time
after proof of loss has been completed. 6. Not
attempting in good faith to make prompt, fair and
Unfair Claims Settlement
equitable claims settlement when the insurer's liability
Practices
has become reasonably clear. 7. Compelling insureds
to institute suits to recover amounts due under a
policy by offering substantially less to settle
immediately. 8. Attempting to settle claims for less
than the amount for which a reasonable person would
believe one was entitled based on written or printed
advertising material accompanying or made a part of
an application. I. Attempting settlement of claims on
the basis of applications that were altered without
notice to knowledge of or consent of insureds.
EXAM QUESTIONS WITH ACCURATE ANSWERS |
GET IT RIGHT!!
Save
Terms in this set (329)
an insurance policy covers the insured starting at
Inception/Expiration Date 12:01am on the day on which coverage begins and
expires at 12:01am on the expiration day of the policy.
Occurrence Date Date of which the loss occurred
The loss report should include the names and
Identification of parties addresses of the parties involved in the loss, the
involved names and addresses of any injured person(s) and the
names and addresses of any witness(s).
Identifies the type of coverage purchased (policy
Policy Form/Number form) and the policy number for the particular policy
purchased by the insured.
Information concerning how, when and where the
Description of the Loss accident or loss happened is an essential element in
any loss report.
Shows the type of coverage(s) purchased as well as
Coverage
the limits of coverage purchased.
, Are amounts paid to compensate the plaintiff for
direct expenses such as medical treatment, lost wages
(both past and future), funeral expenses and
Damages - Special
rehabilitation expenses required because of bodily
Compensatory damages
injury. Special damages are paid for losses that can be
determined and documented. They are often referred
to as "out-of-pocket" expenses.
Are paid for losses that cannot be specifically
measured and itemized in order to compensate the
Damages - General
plaintiff for things such as pain and suffering, loss of
Compensatory Damages
the use of an arm or leg, loss of vision, physical
disfigurement and/or loss of consortium.
Are typically awarded to the plaintiff in addition to
compensatory damages when the defendants
Damages - Punitive
conduct has been especially malicious. Punitive
Damages
damages are awarded to punish the defendant and to
deter others from engaging in similar actions.
, 1. Knowingly misrepresenting relevant facts or policy
provisions relating to the coverage at issue. 2. Failing
to acknowledge with reasonable promptness
communications pertaining to claims. 3. Failing to
adopt and implement reasonable standards for the
prompt investigation of claims. 4. Arbitrary and
unreasonable refusal to pay claims. 5. Failing to affirm
or deny coverage of claims within a reasonable time
after proof of loss has been completed. 6. Not
attempting in good faith to make prompt, fair and
Unfair Claims Settlement
equitable claims settlement when the insurer's liability
Practices
has become reasonably clear. 7. Compelling insureds
to institute suits to recover amounts due under a
policy by offering substantially less to settle
immediately. 8. Attempting to settle claims for less
than the amount for which a reasonable person would
believe one was entitled based on written or printed
advertising material accompanying or made a part of
an application. I. Attempting settlement of claims on
the basis of applications that were altered without
notice to knowledge of or consent of insureds.
