N.C. Claims Adjuster Exam 2023 WITH 100% CORRECT ANSWERS

Inception/Expiration Date an insurance policy covers the insured starting at 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 Identification of parties involved The loss report should include the names and addresses of the parties involved in the loss, the names and addresses of any injured person(s) and the names and addresses of any witness(s). Policy Form/Number Identifies the type of coverage purchased (policy form) and the policy number for the particular policy purchased by the insured. Description of the Loss Information concerning how, when and where the accident or loss happened is an essential element in any loss report. Coverage Shows the type of coverage(s) purchased as well as the limits of coverage purchased. Damages - Special Compensatory damages Are amounts paid to compensate the plaintiff for direct expenses such as medical treatment, lost wages (both past and future), funeral expenses and rehabilitation expenses required because of bodily injury. Special damages are paid for losses that can be determined and documented. They are often referred to as "out-of-pocket" expenses. Damages - General Compensatory Damages Are paid for losses that cannot be specifically measured and itemized in order to compensate the plaintiff for things such as pain and suffering, loss of the use of an arm or leg, loss of vision, physical disfigurement and/or loss of consortium. Damages - Punitive Damages Are typically awarded to the plaintiff in addition to compensatory damages when the defendants conduct has been especially malicious. Punitive damages are awarded to punish the defendant and to deter others from engaging in similar actions. Unfair Claims Settlement Practices 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 equitable claims settlement when the insurer's liability 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. Total Losses on Motor Vehicles/Miscellaneous Provisions 1. If the insurer and the claimant are unable to reach an agreement as to the value of the vehicle, the insurer shall base any further settlement offer not only on the published regional average value of similar vehicles, but also on the value of the vehicle in the local market. 2. Local market value shall be determined by using either the local price of a comparable vehicle or if no comparable vehicle can be found, quotations from at least two qualified dealers within the local market area. Additionally, if the claimant represents that the vehicle was in better than average condition, the insurer shall give due consideration to the condition of the claimant's vehicle prior to the accident. 3. When a motor vehicle is damaged in an amount which equals or exceeds 75 percent of the preaccident actual cash value, an insurer shall "total loss" the vehicle by paying the claimant the preaccident value and in return, receiving possession of the legal title for salvage purposes. 4. The insurer will be responsible for all reasonable towing and storage charges until three days after the owner and the storage facility are notified in writing that the insurer will no longer reimburse the owner or storage facility for storage charges. 5. Loss and claims payments shall be mailed or otherwise delivered within 10 business days after the claim is settled.