2C-2D

Question 1

Define Claim

Answer 1

A formal request to settle the damage.

Question 2

1. Acknowledge the claim.
2. Establish lines of communication.
3. Prepare necessary paperwork.
4. Determine insurer’s liability in the claim.
5. Investigate the losses.
6. Determine the time and cost of repairs.
7. Apply all policy coverages and provisions.
8. Negotiate a settlement.
9. Prepare final reports.
   These are considered what?

Answer 2

The steps of the claims process.

Question 3

How should the adjuster “acknowledge” the claim?

Answer 3

By responding to the claimant either by letter or phone call.

Question 4

What are some ways the adjuster can establish and maintain communication?

Answer 4

By being available to the claimant at any time and providing them with his/her current contact information.

Question 5

What is one form of paperwork that must be submitted within 60 of the loss?

Answer 5

Proof of Loss

Question 6

Explain: determine Insurer’s liability in the claim.

Answer 6

The adjuster should determine whether the insurance policy can apply to the losses being claimed.

Question 7

What might the insurer issue if it is not clear whether the policy covers the losses being claimed, or if the claimant simply took too long to report the losses?

Answer 7

Reservation of Rights

Question 8

Investigation of property claims include:

Answer 8

Inspect Damages
Take Photos
Interview Claimant and Witnesses
Review Police Report
Consult with Professionals

Question 9

For every claim investigation, the adjuster should gather as much critical evidence as possible. True or False

Answer 9

True

Question 10

What are the three parts of a statement?

Answer 10

1. Introduction
2. Body
3. Conclusion

Question 11

When an interview is complete, the interviewee is not allowed to make any corrections to what they stated and they do not have to be told they were recorded. True of False

Answer 11

False

Question 12

What are the two steps taken in the evaluation process?

Answer 12

1. The adjuster must determine the total cost of all damages and injuries.
2. Apply all financial terms of the policy i.e. deductible, co-insurance, exclusions etc.

Question 13

What is the goal of negotiation?

Answer 13

To find a settlement which is fair and equitable for both the claimant and the insurer.

Question 14

Are negotiations always necessary?

Answer 14

No

Question 15

Once a claim has been settled, the adjuster will prepare the final adjustment reports. True or False

Answer 15

True

Question 16

When a claimant submits an offer, what are the four things an adjuster can do?

Answer 16

1. Accept the request and pay the claim
2. Reject the request and deny the claim
3. Negotiate with the claimant
4. Dispute resolution

Question 17

__________ is a legal technique used to resolve disputes outside a court of law.

Answer 17

Arbitration

Question 18

Mediation is similar to arbitration in that it uses a neutral third party, however, the mediator’s decision doe not bind the opposing parties but rather tries to help the parties come to a mutually agreed upon solution. True or False

Answer 18

True

Question 19

Explain the appraisal process.

Answer 19

Both the claimant and insurer select an appraiser. Then, the two appraisers agree upon a third person, called an umpire. In some cases a court will appoint the umpire, if the appraisers cannot agree.

Question 20

When the court declares the legal rights of both parties, but does not decide how to resolve the case this is know as what?

Answer 20

Declaratory Judgment Action

Question 21

What is the final way to resolve a claim dispute and should be the last resort?

Answer 21

Litigation

Question 22

When two parties in a dispute reach an agreement, it is called a _________.

Answer 22

Settlement

Question 23

Full release, scheduled release, partial release, advance payment, no release, and structured settlement are all ___________ ______.

Answer 23

Settlement Options

Question 24

_____ ________ is the most common settlement option.

Answer 24

Full Release

Question 25

_________ _______ is most commonly used in workers comp claims.

Answer 25

Scheduled Release

Question 26

In this settlement option, the insurer agrees to indemnify the claimant for all property damages
first, but the claim is left pending until damages for bodily injury can be negotiated.

Answer 26

Partial release

Question 27

The ______ ______ Settlement allows the insurer to make partial payments to the claimant before the total final settlement amount is reached.

Answer 27

Advance Payment

Question 28

In this settlement option usually, the checks issued to indemnify the claimant act as a substitute for a release form.

Answer 28

The No Release option

Question 29

A ______ _______ breaks the claimant’s indemnification up into a series of smaller
payments over a set period of time, instead of paying it all out at once.

Answer 29

Structured Settlement