2E-2F Flashcards
________ is a process by which two opposing parties attempt to merge their respective interests in an effort to yield a balanced and beneficial outcome for both parties.
Negotiation
_______ ______ are harder to assign dollar amounts to and factor in issues like mental duress and comparative negligence.
Liability Claims
_____ ______ claims addresses the cost to repair or replace, is simple and straightforward.
Property damage
Before negotiations begin, an adjuster must determine what three things?
- Is there coverage?
- What is the insured’s liability? (liability claims only)
- What are the damages?
What damages should never be negotiated?
Punitive
_______ is not strictly speaking a negotiation method; rather, it is a last option when negotiations fail.
Litigation
In _______ insurance claims, the claimant is typically the insured.
Property
Who is the claimant in liability cliams?
Third Party
Everything in a claim file is discoverable. True or False
True
Criminal Trial is when the _____ (plaintiff) vs. ______(defendant).
State
Citizen
Civil trial is when a ______(plaintiff) vs. _______ (defendant).
Citizen
Citizen
Claims disputes are settled in _____ trials.
Civil
When more evidence supports the plaintiff’s case than contradicts it (51% or more evidence supports) this is called what?
Preponderance ofevidence
________ negligence is any negligence on the part of the plaintiff equals no settlement.
Contributory
_________ negligence reduces the settlement by the percentage of the plaintiff’s negligence.
Comparative
Policy ______ establish the terms of the agreement between the insurer and the insured.
Provisions
What are ISO and AAIS?
Insurance Services Office
American Association of Insurance Services
The cancellation/nonrenewal condition establishes when and how the insurer or the insured can
terminate an active insurance contract. True or False
True
An _______ premium is a payment you’ve made for coverage that you never received.
Unearned
The ________ Clause states that any change to a policy form that broadens coverage without increasing the premium will automatically apply to the issued policies of that type.
Liberalization
The representations condition simply states that any information provided by the named insured on the declarations page must be complete and accurate, and clarifies that the insurer has based the provisions of the policy on the information that the insured gave. True or False
True
The Concealment, Misrepresentation, and Fraud condition of a policy protects the _______ from the dishonesty of the insured.
Insurer
Resending a policy means what?
That the policy was never valid to begin with.
The Assignment condition states that a policyholder cannot _____ the policy to someone else unless the insurer agrees to the change in writing.
Transfer
The _______ ______ provision lets the first named insured add other people or
entities to the policy.
Additional Insured
The ______ _______, or Apportionment, clause establishes how the policy will respond if the insured risk is covered by two or more policies.
Other Insurance
A _______ policy will pay first, and up to the policy limit, regardless of the presence of other insurance.
An ______ policy will only pay once the primary policy has paid up to its limits.
Primary
Excess
Under this provision, each policy pays an equal share of the loss up to the lowest policy limit.
Contribution by Equal Shares.
Under the ___ ____ apportionment clause, each insurer agrees to pay its share of the loss according to its share of all policy limits.
Pro Rata
Define nonconcurrency.
The situation in which two or more policies covering the same risk have different inception and expiration dates.
When the amount of insurance covering a risk which exceeds the insurable value of that risk this is known as what?
Overinsurance
After a loss occurs and the insurer indemnifies the policyholder, what happens to the policy limit?
Restoration of Limits, Reinstatement of Limits, or Non-reduction of Limits.
The Legal Action Against an Insurer condition sets certain requirements that must be met before
anyone can sue an insurer. What are they?
Insured must comply with all policy obligations
Insurer not liable for damages above policy limit
What are the policyholder’s duties when a loss occurs?
Notify the police if the loss may have involved a crime.
Notify the insurer about what property was involved, and the circumstances surrounding the loss.
Submit a description of how, where, and when the loss occurred.
Try to prevent further damages, and keep track of expenses incurred doing this
Give insurer a list of damaged property.
Remove coverage for uninsurable losses, manage moral and morale hazards, eliminate duplication of coverages, remove coverages that typical consumers don’t need, remove coverages that need special treatment and lower premiums are all purposes of _______.
Exclusions
The Vacancy condition establishes when a building is considered “vacant”. Why is this important?
Some perils are excluded from coverage when a structure has been vacant for a while, since this increases the chance of certain types of loss.
What does the Recovered Property condition state?
If either party recovers property involved in a claim after the claimant has already been indemnified, that party must notify the other of the recovery.
Property insurance policies have an abandonment clause that prohibits the policyholder from
abandoning damaged property to the ______.
Insurer
The ____ and ____ clause states that, if part of a set or an instrumental part of a whole is lost or destroyed, the policy will pay to replace, restore, or repair the set, or it will pay the difference in the set’s actual cash value that was caused by the loss.
Pair and Set
Premium Audit, Inspection and Surveys, Examination of Books and Records are all __________ provisions.
Commercial
What does the loss payment condition clarify?
How, when, and to whom a claim will be paid.
“Company’s Options” is a provision in the standard ____policy that lays out the insurer’s settlement
options.
Fire
What clause ensures that the lender will be listed as a payee under the policy if a loss or damage occurs?
The loss payable or loss payee clause
Similar to the Loss Payee clause, the _______ Clause protects the lender’s financial interest in
the property, but it takes it one step further. Not only does this provision ensure that the lender will be indemnified in the event of a loss, it also establishes the mortgagee’s rights to receive notice if the policyholder either fails to adhere to the contract, or does not pay policy premiums
Mortgagee
If the policyholder qualifies for replacement cost, when will the receive their Recoverable Depreciation?
Once repairs are complete and the claimant submits proof to the insurer.
In commercial policies, the _______ __ ______ condition protects the property of the insured from
the negligent actions of persons other than the named insured.
Control of Property
The No Benefit to Bailee condition, states that insurance coverage will not benefit a third party who has custody or control of the insured’s property, even if it is with the insured’s granted permission. True or False
True
This provision states that coverage applies to each “insured” separately, as if no other
“insured” existed.
Separation of Insureds
In Liability Coverage Provisions, the Duties after an Occurrence, addressed the policyholder and _____ separately.
Claimant
Finally, a condition sometimes included in liability policies is that the bankruptcy or insolvency of
the insured does not relieve the insurer from the obligation to pay claims. True or False
True
