Claims Investigation & Reporting Standards Flashcards
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Read the first 7 Claims Investigation & Reporting Standards flashcards as text
A 'non-waiver agreement' in claims handling is designed to:
Answer: Allow the insurer to investigate without waiving any policy defenses
A non-waiver agreement allows the insurer to conduct a full investigation or defense without being deemed to have waived coverage defenses.
Under most state statutes, after an insurer accepts liability for a property claim, within how many days must it typically issue payment or provide a written explanation for any underpayment?
Answer: The timeframe set by state prompt-payment law, commonly 15–30 days
Most state prompt-payment laws require payment within a specified window (commonly 15–30 days) once liability is accepted, with penalties for noncompliance.
When an adjuster takes a recorded statement, which practice is considered essential for admissibility and ethical compliance?
Answer: Identifying the parties, date, time, and obtaining consent at the beginning of the recording
Proper recorded statement protocol requires opening identification, date/time, and consent to comply with state wiretapping laws and ensure admissibility.
In appraisal valuation for a total loss vehicle, the adjuster should primarily rely on:
Answer: Current market value based on comparable vehicles using recognized valuation guides
Actual cash value for a total loss vehicle is determined by current market data from recognized sources such as CCC, Mitchell, or NADA guides.
The 'four corners rule' in claims coverage analysis refers to:
Answer: Determining coverage obligations by examining only the allegations within the complaint and the policy terms
The four corners rule requires courts and adjusters to assess duty to defend by comparing only the complaint's allegations against the policy's terms.
An adjuster handling a liability claim involving a minor must be aware that:
Answer: Settlements involving minors typically require court approval to be binding
Most jurisdictions require court approval of settlements involving minors to ensure the settlement is in the minor's best interest.
What does 'subrogation waiver' mean in the context of a claims file?
Answer: The insurer is abandoning its right to pursue the at-fault third party for reimbursement
A subrogation waiver means the insurer agrees not to pursue recovery from the responsible third party, often included in commercial contracts.