Adjusting Losses Flashcards
While at work, Barry suffered a spinal cord injury in a forklift accident. His employer’s insurer settled the claim and paid all of Barry’s initial medical bills, but it also agreed to continue to pay for his weekly visits to the rehabilitation therapist. Which settlement option did Barry receive?
A.
Full release
B.
Advance payment
C.
Partial release
D.
Scheduled payment release
D.
Scheduled payment release
Barry received a scheduled payment release, since the insurer will continue to pay for his future medical bills related to his claim.
Which of the following statements is TRUE of a claim dispute litigated in a state that follows the doctrine of Contributory Negligence?
A.
The settlement amount will be reduced by the percentage of the defendant’s negligence.
B.
If the defendant is found to be at all negligent, she will receive no settlement.
C.
If the plaintiff is found to be at all negligent, she will receive no settlement.
D.
The settlement amount will be reduced by the percentage of the plaintiff’s negligence.
C.
If the plaintiff is found to be at all negligent, she will receive no settlement.
After her business suffered damage in a fire, Jane filed a claim with Acme Insurance, which dispatched Bob to adjust it, even though he was not allowed to adjust commercial claims. He investigated Jane’s losses and submitted his estimate to Acme Insurance, which issued her a settlement check based on that estimate. Bob had _______ because Acme Insurance accepted his estimate and paid Jane’s claim.
A.
express authority
B.
expert authority
C.
apparent authority
D.
agency authority
C.
apparent authority
A/An ____________ plays an advisory role in the negotiation process, working from a neutral position to assist the opposing parties to come to an equitable resolution.
A.
adjuster
B.
mediator
C.
arbitrator
D.
judge
B.
mediator
The correct answer is mediator. An arbitrator makes a legally binding decision based upon the evidence.
An insurance claim is essentially:
A.
a formal offer to repair the damage.
B.
a formal request to settle the damage.
C.
a formal explanation of insurance coverage.
D.
a formal request to repair the damage.
B.
a formal request to settle the damage.
An insurance claim is essentially a formal request from the insured to settle the damage based on the terms of the insurance policy. The insurer only pays for covered repairs; it doesn’t actually repair damaged property.
Dennis was injured when Ruby rear-ended his car while he was stopped at a red light. Which of the following would NOT be a duty that Ruby’s liability insurer may require of Dennis?
A.
Provide proof of the accident
B.
Submit to a physical examination
C.
Promptly report the occurrence to his insurer
D.
Authorize access to his medical records
C.
Promptly report the occurrence to his insurer
Ruby’s liability insurer may require Dennis to provide proof of the accident, but not to promptly report the occurence to his insurer. Ruby is liable for Dennis’ damages, so her insurer may not make Dennis report the accident to his own insurer.
Why might an insurer send a claimant a Reservation of Rights letter?
A.
When the insurer has decided not to cover the loss
B.
When the insurer needs more information before making a final decision
C.
To let the claimant know that the insurer has received all necessary paperwork
D.
To let the claimant know that there is a coverage dispute
D.
To let the claimant know that there is a coverage dispute
An insurer may issue a Reservation of Rights letter at the beginning of the claim process, when there is a coverage dispute, meaning it is unclear whether the policy covers the loss being claimed.
This agent works for only one insurer, and supervises and trains other agents.
A.
Captive Agent
B.
General Agent
C.
Exclusive Agent
D.
Direct Writer
B.
General Agent
An exclusive agent is paid on a commission basis. He represents one insurer at a time and provides quotes and policies from only that company. An agent who works for only one insurer, and supervises and trains other agents is called a general agent.
In a declaratory judgment action:
A.
the court’s decision about the legal rights of the parties is not binding.
B.
the court decides the legal rights of both parties.
C.
the court makes a judgment about the insurer’s unfair settlement practices.
D.
the court resolves the case.
B.
the court decides the legal rights of both parties.
In a declaratory judgment, a court will consider the case and issue a binding decision about the rights of the different parties, but it will not order any action or damages.
Which of the following is NOT a characteristic of a full release settlement?
A.
The insurer pays for certain future “incidentals” related to the claim.
B.
All damages are paid at once.
C.
The claimant signs a Full Release Form.
D.
The insurer pays an immediate, single lump sum to the claimant.
A.
The insurer pays for certain future “incidentals” related to the claim.
In a full release settlement, all damages are paid at once, in a single lump sum, and the claimant signs a full release form that releases the insurer from additional amounts related to the claim.
In a civil trial, the jury makes their decision based upon which of the following?
A.
Preponderance of the evidence
B.
Proof beyond a reasonable doubt
C.
Recommendation of the presiding judge
D.
Conference decision
A.
Preponderance of the evidence
For a bodily injury liability claim, the adjuster must determine all of the following, EXCEPT:
A.
the severity of the injury.
B.
the amount of punitive damages requested.
C.
the type of injury.
D.
the presence of any pre-existing conditions.
B.
the amount of punitive damages requested.
A witness who has had a recorded interview:
A.
is taken more seriously.
B.
must have a lawyer present during the interview.
C.
must have a chance to correct anything that is incorrect.
D.
must do so under oath.
C.
must have a chance to correct anything that is incorrect.
Which of the following is NOT a duty of a captive agent?
A.
Negotiating settlements
B.
Servicing policies
C.
Representing the insurer
D.
Selling insurance policies
A.
Negotiating settlements
It is the duty of captive agents to sell insurance policies, but not to negotiate settlements.
